UNIVERSITY  OF  CALIFORNIA 
AT  LOS  ANGELES 


EDUCATIONAL   HYGIENE 


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EDUCATIONAL  HYGIENE 

FROM  THE 
PRE-SCHOOL  PERIOD  TO  THE  UNIVERSITY 


EDITED    BY 

LOUIS  W.  RAPEER,  Ph.D. 

PROFESSOR  OF  EDUCATION,  PENNSYLVANIA  STATE  COLLEGE 


ILLUSTRATED 


CHARLES   SCRIBNER'S   SONS 

NEW  YORK  CHICAGO  BOSTON 


-;^S   6  G  ( 


COPYKIGHT,    1915,   BV 

CHARLES  SCRIBNER'S  SONS 


^.1 

PREFACE 

The  remarkable  movement  for  the  improvement  of  school 
and  community  health  in  the  last  decade  has  brought  the  school 
into  such  close  and  intimate  relationship  with  the  health  work 
of  the  home  and  the  community  that  ^^ school  hygiene"  is 
hardly  broad  enough  as  a  term  to  include  the  various  health 
aspects  of  the  bringing  up  of  children.  On  the  other  hand, 
the  term  '^ child  hygiene"  is  too  broad.  The  title  "Educa- 
tional Hygiene"  has  been  adopted  for  the  science  and  art  of 
health  preservation  and  promotion  which  the  school  can  more 
or  less  directly  promote  through  its  various  health  agencies. 
When  the  school  nurse  visits  the  homes  and  improves  the 
health  of  the  children  below  school  age  as  well  as  that  of  the 
pupils  of  the  school,  and  when  school  physicians  provide  for 
consultation  hours  for  mothers,  whether  patrons  or  not,  the 
old-time  school  hygiene  is  broadening  out  into  educational 
hygiene.  This  movement  has  but  begun,  and  will  inevitably 
continue  to  expand. 

Educational  hygiene,  furthermore,  is  desirable  as  a  term, 
since  the  subject  is  now  taking  its  place  in  professional  schools 
for  the  training  of  teachers  as  correlative  with  educational 
psychology,  educational  sociology,  educational  philosophy, 
educational  history,  educational  administration,  and  the  like. 
As  educational  administration  was  once  termed  school  admin- 
istration, so  educational  hygiene  was  once  termed  school 
hygiene,  and  the  desirability  of  the  change  in  college  courses 
is  probably  not  less  for  the  latter  than  for  the  former. 

This  comparatively  new  science  is  broad  in  scope,  cover- 
ing as  it  does  the  five  divisions:  medical  supervision,  physical 
education,  school  sanitation,  the  teaching  of  hygiene,  and  the 
hygiene   of   instruction.     Obviously,   very   few   persons   can 

V 


VI  PREFACE 

make  any  just  claims  to  being  experts  in  this  entire  field,  and 
exceedingly  few  persons  have  had  very  much  practical  and 
scientific  experience  in  all  of  them. 

This  volume  is  an  attempt  to  bring  together  in  organized 
form  the  latest  information  and  advice  of  leading  specialists 
in  all  the  large  phases  of  the  subject.  The  hygiene  of  chil- 
dren from  the  standpoint  of  the  school  in  its  relationship  to 
the  home  and  community,  from  the  pre-school  period  up 
through  the  college,  is  sketched  in  such  detail  as  is  possible 
in  so  comprehensive  a  volume.  There  has  been  a  constant 
temptation  to  add  chapters  on  many  new  phases  of  the  school- 
health  movement,  but  the  editor  has  tried  to  limit  himself 
to  certain  "minimum  essentials,"  and  to  give  references  to 
the  voluminous  literature  which  treats  at  length  the  many 
topics  discussed  here  only  briefly.  Each  chapter  and  parts 
of  many  chapters  easily  furnish  topics  for  much-needed  books, 
some  of  which  have  already  been  provided  by  contributors 
to  the  volume.  Effort  has  been  made  to  lead  the  reader 
on  from  these  condensed  statements  to  the  monographic 
literature. 

The  school  as  a  public  agency  ministering  to  the  dominant 
needs  of  the  community  in  the  interests  of  the  state  is  always 
kept  in  mind.  Each  contributor  has  attempted  to  show  how 
the  public  educational  agencies  may  improve  their  assistance 
to  the  solution  of  the  grave  problems  of  national  health  and 
vitality.  Several  chapters  are  comparatively  unique  in  this 
respect,  such,  for  example,  as  those  on  public  co-operation 
for  school-health  progress.  These  give  a  point  of  view  much 
needed  by  the  many  educators  who  have  neglected  educa- 
tional sociology  in  their  professional  studies.  A  chapter  on 
the  health  of  the  teacher  was  planned,  but  omitted  because 
the  matter,  though  of  great  importance,  has  received  little 
scientific  study,  and  because  each  teacher  should  have  access 
to  the  little  book  published  on  this  subject  by  Professor 
Terman.  Another  chapter  on  the  hygiene  of  normal  schools 
could  well  take  a  place  in  Part  IV.     Both  topics  are  briefly 


PREFACE  Vii 

treated,  however,  in  the  chapters  presented.  Attention  is 
called  to  the  appendices  and  to  the  bibliography  at  the  end 
of  the  volume. 

To  the  many  persons  who  have  so  kindly  lent  their  assist- 
ance in  contributing  to  the  volume,  to  his  wife,  to  those  who 
have  furnished  photographs  from  many  parts  of  the  world, 
and  to  the  publishers  for  their  cheerful  co-operation,  the 
editor  is  sincerely  grateful. 

L.  W.  R. 

State  College,  Pa. 


CONTENTS 


PART  ONE 
Health  Sociology 

CHAPTER  i-^  PAGE 

I.    Public  Health  and  the  Public  Schools  .    .        i 

By  Louis  W.  Rapeer,  M.A.,  Ph.D.,   Professor  of  <^ 

Education,  Pennsylvania  State  College. 

II.    The  Public-Health  Movement 22 

By  E.  H.  Lewenski-Corwin,  Ph.D.,  Sec.  Health 
Committee  of  the  New  York  City  Academy  of 
Medicine. 


III.    Health  and  Heredity 45 

By  Chas.  B.  Davenport,  Ph.D.,  Carnegie  Institution. 

rV.    The  Home  Hygiene  of  Children      ....      59 

By  Ernest  B.  Hoag,  A.M.,  M.D.,  Supervisor  of 
Educational  Hygiene,  Long  Beach,  California,  and 
Lecturer  in  Leland  Stanford,  Jr.,  University. 

V.    Public    Co-operation    for    School -Health 

Agencies 82 

By  Clarence  A.  Perry,  A.B.,  Director  of  Division  of 

Recreation,  Russell  Sage  Foundation. 

VI.    The  Social  Centre  and  Educational  Hygiene    103 

By  Edward  J.  Ward,  A.M.,  Professor  of  Social  Centre 
Extension,  University  of  Wisconsin. 


CONTENTS 


PART  TWO 

The  Administration  of  Educational  Hygiene 

CHAPTER  PAGE 

VII.    The  Initiation  of  a  System  of  Educational 

Hygiene  in  a  School  System no 

By  the  Editor. 

VIII.    The  General  Administration  of  Educational 

Hygiene 127 

By  the  Editor. 


IX.    A  Plan  of  State  Co-operation  for  School- 
Health  Progress 147 

By  Geo.  A.  Mirick,  A.M.,  formerly  Assistant  State 
Commissioner  of  Education  of  New  Jersey. 

X.    City  School-Health  Administration     .    .    .     153 

By  Geo.  R.  Leslie,  Formerly  Director  of  Health  and 
Clinical  Psychology,  Los  Angeles  Public  Schools. 

XI.    Rural  School-Health  Administration       .    .     178 

By  \V.  L  Larsox,  S.B.,  State   Inspector  of  Rural 
Schools,  Madison,  Wisconsin. 


PART  THREE 
The  Divisions  and  Practice  of  Educational  Hygiene 

I.   MEDICAL   supervision    OF   SCHOOLS 

XII.    The  Standardization  of  the  School  Medical 

Service 197 

By  the  Editor. 

XIII.    The  School  Nurse  and  Her  Work  ....    230 

By  LiNA  Rogers  Struthers,  R.N.,  First  Municipal 
School  Nurse  of  America,  recently  Supervisor  of 
School  Nurses,  Toronto,  Canada. 


CONTENTS  XI 


XIV.    Public  School  Clinics 243 

By  Jesse  D.  Burks,  Ph.D.,  Director  of  Municipal 
Bureau  of  Efficiency,  and  Frances  Williston 
Burks,  A.B.,  Los  Angeles,  California. 

XV.    Open-Air  and  Open- Window  Schools    .     .    .     256 

By  S.  C.  KiNGSLEY,  A.M.,  Director  of  the  Elizabeth  ^ 

McCormick    Memorial    Fund,    formerly    Superin- 
tendent of  United  Charities,  Chicago,  Illinois. 

XVE.    School  Feeding 273 

By  Louise  Stevens  Bryant,  Ph.D.,  Lecturer  on 
Psychology  at  the  Pennsylvania  School  for  Social 
Service,  Philadelphia;  Probation  Officer  of  the 
Criminal  Division  of  the  Municipal  Court  of  Phila- 
delphia; formerly  Assistant  in  the  Psychological 
Clinic,  University  of  Pennsylvania. 

XVII.    Medical  Supervision  and  the  Exceptional 

Child 294 

By  Clinton  P.  McCord,  A.B.,  M.D.,  Director  of 
Health,  including  the  Medico-Psychological  Labora- 
tory, Albany,  New  York,  Public  Schools ;  Lecturer 
on  Child  Hygiene  in  Albany  Medical  College. 


II.    SCHOOL   sanitation 

XVIII.    Hygienic  School  Environment 312 

By  Superintendent  L.  N.  Hines,  A.M.,  Crawfords- 
viUe,  Indiana,  President  of  the  Division  of  Child 
Hygiene  of  the  National  Education  Association; 
Associate  Editor  of  the  Educator  Journal. 

XIX.    School  Sanitation  Standards 330 

By  the  Editor. 

XX.    Rural  School  Sanitation 355 

By  A.  C.  Monahan,  B.S.,  Rural  School  Speciahst, 
U.  S.  Bureau  of  Education. 

in.  PHYSICAL  education 
XXI.    Play  and  Playgrounds  in  Cities      ....    380 

By  Geo.  E.  Johnson,  Ph.D.,  of  the  New  York  School 
of  Philanthropy,  formerly  Supervisor  of  Play- 
grounds, Pittsburgh,  Pennsylvania. 


Xll 


CONTENTS 


CHAPTER 

XXIL 


Physical  Education  in  Elementary  Schools    410 

By  C.  Ward  Crampton,  M.A.,  M.D.,  Director  of 
Physical  Training,  Athletics,  and  Hygiene  in  the 
Public  Schools  of  New  York  City,  Secretary  of  the 
Public  Schools  Athletic  League. 


XXIII.  Physical  Education  and  Athletics  in   the 

High  Schools 439 

By  Edgar  Faitver,  A.B.,  M.D.,  Professor  of  Physical 
Education,  Wesleyan  University. 

XXIV.  Play  and  Recreation  at  the  Rural  School    456 

By  S.  H.  Curtis,  Ph.D.,  Lecturer  on  Public  Recrea- 
tion, Albion,  Michigan;  formerly  Secretary  of  the 
Playground  Association  of  America. 


w^ 


XXV. 


IV. 


U^ 


the  teaching  of  hygiene      _ 

The  Teaching  of  Hygiene  in   Elementary  \ 

Schools 472    \ 

By  J.  Mace  Andress,  A.M.,  Director  of  the  Depart- 
ment of  Psychology  and  Hygiene,  State  Normal 
School,  Worcester,  Massachusetts. 


XXVI.    Health  Teaching  in  High  Schools  .... 

By  W.  S.  Small,  Ph.D.,  Principal  of  the  Eastern  High 
School,  Washington,  D.  C. 


494 


XXVII.    Professional    Training    of    School-Health 

Workers 518 

By  Ella  Phillips  Crandall,  Executive  Secretary 
of  the  National  Organization  for  Public  Health 
Nursing,  New  York  City,  and  the  Editor. 

XXVIII.     Industrial  Hygiene  and  Vocational  Educa- 
tion   538 

By  the  Editor. 


XXIX.    Sex  Hygiene  and  Sex  Education     .... 

By  Ira  S.  Wile,  M.S.,  M.D.,  Editor  Medical  Review 
of  Reviews ;  Lecturer  in  the  New  York  University 
School  of  Pedagogy;  member  of  the  Board  of  Edu- 
cation, New  York  City. 


547 


CONTENTS  XIU 


V.   THE   HYGIENE   OF   INSTRUCTION 

CHAPTER  PAGE 

XXX.    The  General  Hygiene  of  Instruction     .    .    567 

By  Arthur  K.  Beik,  Ph.D.,  Assistant  Professor  of 
Psychology  and  Pedagogy,  Olivet  College. 

XXXI.    The  Hygiene  of  School  Subjects     ....    586 

By  Arthur  K.  Beik,  Ph.D.,  Assistant  Professor  of 
Psychology  and  Pedagogy,  Olivet  College. 


PART  FOUR 

The  Hygiene  of  the  College 

XXXII.    The  Hygiene  of  Women's  Colleges     .    ,    .    602 

By  Kristine  Mann,  A.M.,  M.D.,  Health  Director  of 
the  Department  Store  Educational  Association, 
New  York  City,  formerly  Instructor  in  Hygiene  and 
Physical  Education,  Wellesley  College. 

XXXIII.    The  Hygiene  of  Men's  Colleges     ....    617 

By  Geo.  R.  Meylan,  A.B.,  M.D.,  Professor  of  Phys- 
ical Education,  Columbia  University. 

Bibliography 629 

Appendix  I:  Health  and  School  Progress  .    635 

Appendix  II:  Communicable  Diseases  Among 
Children Facing     642 

Appendix  III:  Physical-Record  Card,  Girls' 
High  School,  Providing  for  Four  Annual 
Examinations 642 

Appendix  IV:  Letter  to  Parents  on  Care  of 
Teeth 643 

Index 647 


ILLUSTRATIONS 

Doors  that  insure  protection  in  case  of  fire Frontispiece 

PAGE 

Deaths  from  all  causes  in  Indiana 8 

Growth  of  the  registration  area  for  deaths,  1900-1911      ...  12 

Death-rate  per  1,000  population  for  States  included  in  registra- 
tion area  in  1900 15 

Practical  health  instruction  in  the  care  of  the  sick,  Woodward 

High  School,  Cincinnati,  O Facing  24 

Typhoid  fever  deaths  in  Indiana 29 

Dressing  the  baby.     Little  Mothers'  League,  Toronto,  Canada 

Facing  32 

Diarrheal  diseases  in  Indiana 35 

Measles  deaths  in  Indiana 38 

Tuberculosis  deaths  in  Indiana 38 

Diphtheria  deaths  in  Indiana 39 

Scarlet  fever  deaths  in  Indiana 39 

A  co-operative  playground,  Lexington,  Mo.      .      .      .       Facing  84 

The  first  water  in  the  swimming-pool  of  the  co-operative  play- 
ground at  Lexington,  Mo Facing  86 

A  home  and  school  meeting  at  the  University  of  Chicago  Ele- 
mentary School Facing  88 

Child-welfare  exhibits Facing  90 

School  dental  clinic  at  Cincinnati,  O.  (i)     .      .      .      .        Facing  96 

School  dental  clinic  at  Cincinnati,  O.  (2)      .      .      .      .        Facing  96 

Auditorium  in  William  Penn  High  School  for  Girls,  Philadelphia 

Facing  106 

XV 


XVI  ILLUSTRATIONS 

PAGE 

School  nurse  giving  parents'    notifications  to   school-children, 

Toronto,  Canada Facing  162 

School  nurses  taking  school-children  to  clinics,  Toronto,  Canada 

Facing  162 

Snellen  test  sheet Between  pages  168  and  i6g 

A  sanitary  school  hack  for  transporting  pupils  to  consolidated 

schools Facing  180 

Interior  of  school  hack Facing  180 

Model  rural  school,  Kirksville,  Mo Facing  184 

Interior  of  a  rural  school,  illustrating  method  of  ventilation,  use 

of  single  seats,  and  sanitary  drinking-fountain     .      .     Facing  184 

A  thorough  physical  examination  in  Cincinnati  public  schools 

Facing  216 

Relative  frequency  of  school  ailments  in  25  cities 

Between  pages  228  and  229 

School  nurse  making  home  visits,  Toronto,  Canada     .       Facing  234 

Nose-blowing  drill  in  the  classroom,  Toronto,  Canada        Facing  236 

The  school  nurse  in  the  home,  Boston  Public-School  Hygiene 

Department Facing  238 

"Little  mothers"  taught  to  wash  "baby  brothers"  in  summer 

playgrounds,  Hartford,  Conn Facing  240 

Dental  clinic;  operating-room,  Strasburg,  Germany         Facing  248 

Orthopedic  Clinic,  Dunfermline,  Scotland         .      .      .        Facing  248 

Orthopedic  Clinic,  Dunfermline,  Scotland        .      .      .        Facing  252 

Open-air  classroom,  exterior,  Hackensack,  N.  J.     .      .       Facing  258 

Open-air  classroom,  interior,  Hackensack,  N.  J.     .      .       Facing  258 

Open-air  school,  first  grade,  Sacramento,  Cal.  .      .      .       Facing  262 

Weight    recorded   each    Monday   and    Friday,    Dyer   Open-Air 

School,  Cincinnati,  O Facing  266 

Open-air  school  dance  on  the  roof,  Dyer  School,  Cincinnati,  O. 

Facing  268 


ILLUSTRATIONS  XVll 

PAGE 

Tubercular    children    attending    the    "  Httle    red  schoolhouse " 

Facing  270 

High-school  girls  at  luncheon Facing  274 

Relative  food  value  of  school  and  street  lunches 275 

Scientific  feeding  of  children,  William  Penn   High    School  for 

Girls,  Philadelphia,  Pa Facing  278 

An  exhibit  used  at  the  Fourth  International  Hygiene  Congress 

Facing  282 

Ratio  of  window  space  to  floor  space  in  Ohio  rural  schools     .      .  315 

Country  school  farm 323 

Fire  protection  legislation  for  schoolhouses 335 

Laws  relating  to  schoolhouse  construction  in  each  State  in  191 2  335 

One  of  the  newer  types  of  high-school  buildings     .      .        Facing  340 

The  Austral  window,  showing  method  of  ventilating  without 

drafts Facing  346 

Moulthrop  school  desk-chair Facing  350 

The  "panic  bolt" Facing  350 

Basement  plan,  model  rural  school,  Kirksville,  Mo 361 

First  floor  plan,  model  rural  school,  Kirksville,  Mo 362 

A  model  consolidated  school  building Facing  362 

Part  of  the  basement  of  a  renovated  rural  school  .      .        Facing  362 

Attic  plan,  model  rural  school,  Kirksville,  Mo s^3 

Looking  into  library  and  cloak-rooms  of  the  Cross  Roads  School 

Facing  364 

Corner  of  kitchen,  rural  school  in  Louisiana      .     .      .        Facing  364 

Sanitary  drinking-fountains  for  rural  schools     .      .      .        Facing  366 

Sanitary  drinking-fountain 367 

Sanitary  chemical  closet Facing  368 

Jacketed  stove  and  ventilating  system  of  modern  type  for  rural 

schools Facing  368 


XVIU  ILLUSTRATIONS 

PAGE 

Kentucky  sanitary  privy 369 

Outdoor    exercise    at    the    University    of    Chicago    Elementary 
School Facing     382 

Calisthenic  drill  by  three  thousand  pupils  from  the  city  schools 
of  Manila Facing     386 

Outdoor  physical  training  at  Motley  School,  Minneapolis  Facing  390 

School  play  activities  at  Milwaukee,  Wis Facing  398 

Tennis  and  volley-ball  at  Pasadena,  Cal Facing  398 

A  public-school  swimming-pool Facing  400 

A  volley-ball  game  over  a  tennis-net.  Oak  Park  Grammer  School, 
Sacramento,  Cal Facing     402 

Girls  at  playground  ball  and  volley-ball;  boys  at  tennis      Facing     402 

A  vacant-lot  playground  well  used  in  Boston,  Mass.   .        Facing    404 

A  play  corner  at  Cincinnati,  showing  a  variety  of  apparatus 

Facing    406 

Typical  sand-box  play,  Hartford,  Conn Facing    408 

Folk-dance,   Kinderpolka,   Lincoln    Elementary   School,  Sacra- 
mento, Cal Facing     416 

Prospective  teachers  learning  folk-dancing  and  gymnastic  drills 
at  the  State  Normal  School,  Indiana,  Pa.     .      .      .        Facing     420 

National  dances,  playground  festival,  public  schools,  Hackensack, 
N.  J Facing    424 

Boys  of  the  University  of  Chicago  Elementary  School  in  their 
gymnasium  suits Facing     430 

Gymnastics  in  the  William  Penn  High  School  for  Girls,  Phila- 
delphia       Facing     440 

A  girls'  gymnasium  class  at  the  University  of  Chicago  Elementary 
School Facing     444 

A  boys'  gymnasium  class  in  an  elementary  school  at  Milwaukee, 
Wis Facing     446 

National  dances,  playground  festival,  public  schools,  Hackensack, 
N.  J Facing    448 

The  girls'  basket-ball  team  from  Iloilo,  P.  I.     Champions  of  the 
\'isayan  Islands,  1914 Facing     448 


ILLUSTRATIONS  XIX 

PAGE 

Schoolroom  game,  Cleveland,  O Facing    452 

Schoolroom  games Facing     458 

Boys  on  giant  stride  and  girls  at  volley-ball  at  Pasadena,  Cal. 

Facing    462 

Physical  training  in  the  open  air,  Pasadena,  Cal.  .      .       Facing    462 

Tomatoes — summer-school  garden,  Montclair,  N.  J.    .        Facing     470 

School  gardens Facing     470 

"Tooth-brush  drill,"  Boston  public  school.  Department  of  Hy- 
giene     Facing     482 

Inculcating  the  tooth-brush  habit  and  ideal  at  Cincinnati,   O. 

Facing     482 

A  special  class  in  Albany,  N.  Y Facing     540 

A  group  of  ungraded  school-children,  Albany,  N.  Y.    .        Facing     540 

A  class  in  industrial  training,  Boys'  Special  School,  Cincinnati,  O. 

Facing     544 

One  of  the  many  types  of  outdoor  recreation  and  athletics  at 
Wellesley  College Facing     606 

Examination  of  vision  by  the  retinoscope.  College  of  the  City  of 
New  York Facing     618 

Swimming-pool  at  the  College  of  the  City  of  New  York     Facing     620 

The  Yale  bowl,  where  70,000  view  the  great  games  and  partici- 
pate sufficiently  to  make  a  positive  contribution  to  physical 
and  mental  health Facing     622 

The  great  public-school  stadium,  playground,  and  recreation 
centre  at  Tacoma,  Wash Facing     622 

Stadium  for  the  athletic  field  of  the  College  of  the  City  of  New 
York Facing     624 

Secondary  school  and  gymnasium  of  the  College  of  the  City  of 
New  York Facing     624 

Health  instruction  by  the  gymnasium  teacher  for  secondary  and 
college  students  at  the  College  of  the  City  of  New  York    Facing     626 


EDUCATIONAL  HYGIENE 

PART  I 

HEALTH  SOCIOLOGY 

CHAPTER  I 

PUBLIC    HEALTH    AND    THE    PUBLIC    SCHOOLS 

The  Public-Health  Problem. — In  a  recent  volume  Price 
Collier  has  asserted  that  "the  earth  will  be  as  cold  as  the 
'moon  before  all  men  realize  that  the  only  real  wealth  is 
health";  1  and  certainly  the  experiences  of  the  past  seem  to 
warrant  his  conclusion.  Health  is  and  will  always  remain  a 
fundamental  value  of  life,  practically  inseparable  from  life 
itself.  Yet  on  every  side,  the  world  over,  we  are  confronted 
by  the  fact  that  health,  including  normal  physical  develop- 
ment, longevity,  and  splendid  bodily  resistance,  is  being 
only  very  inadequately  achieved  by  millions  of  people. 
When  a  third  of  all  the  children  born  with  such  cost  into  a 
civilized  community  like  America  die  before  the  age  of  five, 
and  half  are  dead  before  the  age  of  twenty-three,  when  the 
average  term  of  life  is  but  thirty-eight  years  instead  of  fifty 
or  sixty,  and  when  illness,  deformities,  and  multifarious 
physical  defects  are  afflicting  the  race  with  an  immense  and 
overburdening  cost,  it  would  seem  that  every  agency  which 
the  state  has  at  its  disposal  would  be  vigorously  engaged  in 
preventing  and  eliminating  from  the  world,  or  lessening  ta  a 
fraction  of  their  present  destructiveness,  these  enemies  of 
health  and  vitality. 

•"Germany  and  the  Germans"  (Scribners). 


2  EDUCATIONAL  HYGIENE 

Instead  of  such  universal  and  united  resistance  to  a 
•common  foe,  what  do  we  find?  In  the  first  place,  we  find  a 
[great  private  medical  profession  that  lives  by  the  diagnosis 
!  and  cure  of  existing  ailments,  but  not  primarily  by  their  pre- 
vention and  final  elimination  from  the  world.  Outside  of 
China  disease  has  long  been  the  friend,  not  the  enemy,  of 
physicians,  for  it  has  been  disease  that  has  brought  to  them 
their  Hvelihood.  To  slay  the  food-bringer  has  not  been  the 
policy  of  the  past,  and  it  is  one  of  the  greatest  glories  of  the 
present  that  an  increasing  number  of  physicians  are  becom- 
ing willing  to  make  such  sacrifice.  Unfortunately,  the  social 
situation  has  demanded  the  wrong  thing.  It  should  be  made 
the  physician's  chief  mission  and  means  of  livelihood  to  ban- 
ish from  the  earth  the  enemies  of  health  and  physical  per- 
fection. 

This  Utopian  condition  is,  indeed,  coming  swiftly  upon 
us  in  the  very  rapid  increase  of  public  agencies  manned  by 
doctors  and  nurses  in  great  numbers.  Such  public  hygienists 
as  Winslow  prophesy,  indeed,  the  complete  or  almost  complete 
socialization  of  health  service  in  the  next  few  decades.^  Great 
insurance  societies  are  finding  it  to  their  advantage  to  keep 
their  policy-holders  well  by  periodical  examinations,  health 
instruction,  nipping  incipient  ailments,  and  by  sending  visit- 
ing nurses  to  those  who  need  their  help.  Our  governmental 
health  service,  in  the  form  of  local,  State,  and  national  health 
departments  or  bureaus,  has  a  far  greater  motive  for  disease 
prevention,  but  it  is  in  general,  though  with  many  brilliant 
exceptions,  exceedingly  inadequate  and  inefficient.  These 
bureaus,  however,  are  everywhere  so  increasing  their  stafTs 
that  preventive  medicine  is  really  making  fairly  rapid  progress. 
Many  agencies,  more  or  less  efl&cient,  are  steadily  tending  to 
make  the  work  of  the  old-time  curative-medicine  doctor  less 
necessary,  and  in  many  places  the  clash  between  the  factors 

•"Efficiency  in  the  Public-Health  Campaign,"  in  the  North  American  Re- 
view, June,  19 13.  A  free  bulletin  of  the  New  York  State  Board  of  Health, 
Albany. 


PUBLIC   HEALTH   AND   THE   PUBLIC    SCHOOLS  3 

for  eliminating  the  causes  of  disease  and  for  treating  disease 
after  it  has  come  into  being  is  not  as  mild  as,  to  the  outsider, 
it  may  appear.  The  inevitable  movement  will  be  to  push  the 
curative  doctor  over  into  the  field  that  for  the  time  being 
cannot,  by  the  best  efforts,  both  public  and  private,  be  con- 
quered by  preventive  measures,  including  hygiene,  sanita- 
tion, physical  development,  etc. 

Because  of  the  comparative  lack  of  development  of  pre- 
ventive medicine  and  public-health  agencies,  we  see,  in  the 
second  place,  more  clearly  than  ever  before,  a  great  host  of 
only  partially  utilized  agencies  for  reducing  or  eliminating  our 
disgraceful  and  enormous  death,  illness,  and  physical-defects 
losses.  Fundamentally,  of  course,  the  elimination  of  un- 
necessary ill  health  depends  upon  the  two  factors  of  nature 
and  nurture,  of  eugenics  and  hygiene.  Doctor  Davenport 
shows  briefly  in  a  later  chapter  the  considerable  and  largely 
unguessed-at  influence  of  heredity  upon  the  amount  of  disease 
and  physical  defects  among  human  beings.  Ideally,  of  course, 
we  should  all  be  the  offspring  of  physically  and  mentally  per- 
fect parents.  This  would  be  our  greatest  insurance  for  the 
possession  of  like  characteristics.  To  help  in  some  measure 
to  bring  about  such  a  happy  state,  to  eliminate  many  of  our 
most  terrible  losses  in  the  way  of  feeble-mindedness  and  gross 
physical  imperfections  that  are  inheritable,  and  to  give  sound 
biological  advice  to  the  hygienist  working  with  environment,  in 
order  that  he  may  prevent  the  bringing  out  of  native  weak- 
nesses— these  are  the  objects  of  many  eugenic  agencies  now 
springing  rapidly  into  being. 

Public-Health  Agencies.— Certain  factors  in  heredity  are, 
then,  of  utmost  importance  to  the  hygienist,  but  his  chief 
work  falls  in  the  field  of  nurture,  of  environmental  control.^ 
It  is  the  duty  of  the  state  to  insure,  within  reasonable  limits, 
that  its  children  and  future  citizens  be  well  born;  but  the 
duty  which  is  far  clearer  and  simpler  at  present  is  that  of 
providing  such  environmental  control  of  the  population,  young 

'  See  Winslow,  "  Man  and  the  Microbe,"  Popular  Science  Monthly,  July,  1914. 


4  EDUCATIONAL  HYGIENE 

and  old,  that  disease,  premature  death,  and  physical  defects 
may  be  reduced  to  a  minimum.  The  public  agencies  for  such 
health-control  may  be  briefly  and  tentatively  classified  as 
follows : 

1.  Medical  or  health  supervision  of  the  population. 

2.  Securing  in  all  ways  a  sanitary  environment. 

3.  Medical  or  health  research. 

4.  Educational  control  of  the  population. 
Since  this  is  a  free  country,  where  very  much  depends 

upon  the  choice  of  the  people,  the  last-mentioned  means, 
educational  control  of  the  population,  far  outweighs  in  im- 
portance all  the  others.  Every  agency  of  health  amelioration 
soon  discovers  and  heralds  abroad  that  the  progress  of  health 
measures  depends  absolutely  and  finally  upon  the  education 
of  the  people,  old  and  young.  If  laws  for  health  improvement 
are  to  be  enacted,  they  must  have  the  support  of  an  enlight- 
ened public  both  before  and  after  they  are  passed;  if  health 
measures  are  to  be  practised  they  must  through  some  form  of 
educational  effort  be  made  habit.  In  short,  the  most  funda- 
mental means  of  health  improvement  is  through  education 
in  the  habits,  knowledge,  ideals,  and  the  physical  develop- 
ment which  go  with  socially  efiticient  right  living,  personal  and 
public.  Such  education  begins  at  birth  and  lasts  throughout 
life.  It  can  only  be  partially  monopolized  by  the  public 
educational,  or  schooling,  system.  And  yet,  since  the  educa- 
tional system  is  extending  its  beneficent  influence  over  those 
of  pre-school  and  post-school  age,  and,  moreover,  since  it 
influences  individuals  in  their  most  plastic  and  formative 
period,  that  of  childhood,  the  public  school  stands  out  easily 
as  the  greatest  single  instrument  for  health  promotion  pos- 
sessed by  the  civilized  world. 

Educational  Hygiene. — In  its  widest  sense,  then,  edu- 
l  cational  hygiene  is  broader  than  the  school,  including,  as  it 
\  does,  all  agencies  for  the  promotion  of  health  measures 
;  through  education.  The  boards  of  health,  the  newspapers 
;'    and  magazines,  the  public  lecturers  of  the  American  Medical 


PUBLIC   HEALTH   AND   THE   PUBLIC    SCHOOLS  5 

Association,  the  leading  insurance  companies,  the  anti- 
tuberculosis and  other  societies,  and  many  other  agencies^  \ 
are  very  largely  engaged  in  the  field  of  educational  hygiene. 
In  the  narrower  sense,  as  used  in  this  volume,  educational 
hygiene  is  the  name  given  to  all  the  phases  of  health  promo- 
tion work  which  may  be  and  are  undertaken  by  schools, 
especially  public  schools,  from  kindergarten  through  college, 
for  people  of  all  ages,  but  especially  for  those  between  the 
ages  of  four  and  twenty-four. 

We  have  for  some  time  had  the  science  of  educational 
psychology,  used-^specially  in  the  training  of  teachers.  We 
have  also  ed^ucational  sociology,  educational  administration, 
educational  history,  etc.,  and  it  is  high  time  that  we  have  an 
educational  hygiene.  The  exclusive  emphasis  upon  educa- 
tional psychology  in  the  past  has  led  to  a  lop-sided  knowledge 
of  the  educational  process  and  the  nature  of  children.  The 
pathological  and  physical  child  is  at  least  as  important  from 
the  state's  point  of  view  as  is  the  ignorant  and  mental  child. 
This  volume  attempts  to  treat  of  the  health  and  physical 
well-being  of  the  people,  old  and  young,  as  it  can  be  afTected 
by  public  schools.  The  future  extensions  of  the  school  in  this 
direction  are  beyond  prophecy. 

That  the  school  may  directly  affect  the  health  and  normal 
physical  development  of  persons  who  do  not  at  the  time  at- 
tend the  school  as  pupils  hardly  needs  demonstration,  and  will 
be  plentifully  illustrated  in  the  following  pages.  When  school 
physicians  and  nurses  have  consultation  hours  for  mothers 
with  babes  in  arms,  when  the  nurses  go  day  after  day  into 
the  homes  to  help  improve  home  hygiene,  when  the  schools 
are  used  as  social  centres  for  the  health  education  and  recrea- 
tion of  the  community,  when  there  is  health  vocational  guid- 
ance in  and  after  the  school  period,  when  schools  use  news- 
papers and  various  civic  organizations  for  the  promotion  of 

>  See  Dresslar  on  "Public  Health  Teaching  Agencies"  and  "Methods  and 
Means  of  Health  Teaching,"  in  the  191 2  and  1913  Reports  of  the  U.  S.  Bureau 
of  Education. 


6  EDUCATIONAL  HYGIENE 

the  health  of  the  children  and  community,  then  we  have  an 
influence  that  is  far  broader  than  the  old-time  "school  hy- 
giene," an  influence  that  may  very  appropriately  go  by  the 
name  of  educational  hygiene. 

The  various  phases  of  this  rapidly  developing  science  we 
shall  briefly  sketch  as  medical  supervision,  physical  education, 
school  sanitation,  the  teaching  of  hygiene,  and  the  hygiene  of 
methods  of  teaching  and  management. 

The  National  Health  Problem. — Before  we  can  say  what 
the  schools,  through  the  development  of  educational  hygiene, 
can  do  for  the  health  and  happiness  of  our  nation,  it  is  neces- 
sary for  us  to  face  the  actual  health  problems  of  the  people 
and  nation.  The  principal  problems  of  the  people  and  nation 
set  the  principal  problems  for  their  public  educational  sys- 
tems. If  the  educational  systems  of  the  country  can  be 
helped  to  concentrate  their  energies  upon  the  really  big 
problems  of  life  instead  of  upon  so  many  little  or  obsolete 
ones,  their  social  efficiency  can  undoubtedly  be  marvellously 
increased. 

The  principal  phases  of  the  national  health  problem  are 
shown  in  the  number  of  preventable  deaths,  in  the  prevailing 
and  preventable  amount  of  illness,  or  morbidity,  and  in  the 
number  and  preventability  of  physical  defects  which  lower 
vitality  and  reduce  working  efficiency  and  happiness.  In 
a  somewhat  careful  investigation,  published  elsewhere,^  the 
writer  has  attempted  to  compute  from  mortality  statistics 
and  other  sources,  by  the  methods  used  by  life-insurance 
statisticians,  .the  nature  and  extent  of  the  national  and  school 
health  problem.  We  can  here  only  briefly  summarize  our 
relatively  inaccurate  and  tentative  findings,  in  the  assurance, 
however,  that  great  as  they  may  seem  the  results  are  probably 
not  exaggerations. 

I,  Death  Losses. — The  death  losses  to  our  country  are  enor- 
mous and  largely  preventable.     The  judgment  of  the  best 

'  "Srhool  Health  Administration,"  published  by  Teachers  College,  Columbia 
University,  chapters  I  and  II.     (Out  of  print.) 


PUBLIC   HEALTH  AND   THE   PUBLIC   SCHOOLS  7 

experts  versed  in  mortality  statistics  and  in  the  results  of 
various^rms  of  hygienic  improvement  here  and  abroad  agree 
pretty  well  with  Professor  Fisher's  estimates  of  preventability 
given  in  his  book  on  "National  Vitality."^  His  estimate, 
arrived  at  with  the  assistance  of  thirty  experts  in  health) 
matters,  is  that  in  general  about  42  per  cent  of  the  deaths  oJ 
persons  in  the  United  States  could  be  reasonably  prevented 
or  postponed,  "ii  knowledge  now  existing  among  well-in- 
formed men  in  the  medical  profession  were  actually  applied 
in  a  reasonable  way  and  to  a  reasonable  extent."  An  exami- 
nation of  his  tables  showing  his  estimates  of  preventability 
for  deaths,  from  the  manifold  causes,  will  convince  most 
intelKgent  persons  that  they  are  fairly  conservative  and  that 
they  are  based  on  present  data,  counting  not  at  all  on  the  as- 
sured advance  in  preventive  medicine. 

Some  of  the  leading  facts  relating  to  this  great  problem  are 
as  follows : 

1.  One-fifth  of  all  the  children  born  each  year  in  this 
country  die  before  they  are  a  year  old,  approximately  a  half- 
million.  Where  there  are  fairly  efficient  and  developed 
health  agencies,  such  as  boards  of  health,  carefully  conducted 
infant-mortality  campaigns  in  this  country  have  cut  this 
death-rate  to  about  one-tenth  of  these  proportions. 

2.  Half  of  the  persons  born  in  our  country  die  before  they 
are  twenty-three  years  of  age,  and  about  half  of  these  before 
the  age  of  five. 

3.  The  average  age  of  persons  dying  is  gradually  rising, 
but  is  still  below  the  age  of  forty — near  thirty-eight. 

4.  Approximately  1,600,000  of  our  population  die  each 
year — about  670,000  (42  per  cent)  of  reasonably  preventable 
diseases.  The  economic  losses  due  to  these  deaths  are  at  least 
a  billion  dollars.  These  losses  come  in  the  form  of  public  and 
private  care  of  the  sick  and  dead  and  in  lost  wages,  but  prin- 
cipally in  the  form  of  cut-off  potential  earnings.  The  value 
of  a  life  at  various  ages  can,  in  general,  be  somewhat  easily 

^  Also  published  as  a  government  report. 


EDUCATIONAL   HYGIENE 

DEATHS   FROM   ALL  CAUSES   IN   INDIANA 
All  Ages 

'°'2  V//////^/A  Average  for  preceding  three  years 


500   1000      2000       3000       4000       5000 


— ■   Diphtheria  and  Croup 

— — >  Suicides 

S5S|  Other  Forms  of  Tuberculosis 

'/A'v/^v.Ti  Influenza 


I  Unclassified 
Causes 


'Oro'c  Heart  Disease 
1  Tuberculosis  of  the  Lungs 
"Acute  Nephritis  and  Brights'  Disease 
'External  Causes  (Suicides  Excepted) 
'Hemorrhage  and  Softening  of  the  Brain 
'Cancer  and  Other  Malignant  Tumors 
rCongenital  Debility  and  IVlalformations 
Pneumonia 
I  Diarrhoea  and  Enteritis  (under  two  years) 
'  Other  Diseases  of  the  Respiratory  System  (T.B.  Excepted) 
'  Diseases  of  the  Stomach  (Cancer  Excepted) 
3  Typhoid  Fever 


CZ3  Senility 
[2223  Appendicitis 
ww.M  Cirrhosis  of  the  Liver 

sa Other  Epidemic  Diseases 
TTTTT^  Intestinal  Obstruction 
ps3za  Whooping  Cough 
77T^  Acute  Bronchitis 
^ra  Chronic  Bronchitis 
7T-77:\  Puerperal  Septicemia 

1  Other  Puerperal  Accidents  of  Pregnancy  and  Labor 
2ZZ3  Tuberculosis  Meningitis 

)pzi  Non  Cancerous  Tumor  &  other  diseases  of  the  female  genital  organs 
rrr\  Scarlet  Fever 

Malaria 
^Simple  Meningitis 

Hernia 
■77m  Measles 

3  Poliomyelitis  (Acute  Anterior) 
3  Cerebro  spinal  fever 
a  Unknown  or  ill  defined  diseases 
\  Cholera  Nostras 
[Smallpox 


PUBLIC   HEALTH   AND   THE   PUBLIC    SCHOOLS  9 

computed,  and  the  average  value  for  all  ages  used  by  econo- 
mists is  $1,700. 

The  table  on  pages  10  and  11,  taken  from  "School  Health 
Administration,"  shows  in  some  detail  a  condensation  of  the 
1910  mortality  statistics  made  by  the  author,  and  shows  also 
the  deaths  of  children  of  school  age  and  the  age  groups  of 
most  deaths.  The  registration  area  is  composed  of  those 
States  and  cities  sensitive  enough  to  their  health  needs  to 
enforce  reasonable  registration  of  deaths.  It  reaches  about 
three-fifths  of  the  population.^ 

Those  who  wish  to  study  educational  hygiene  in  relation 
to  national  and  community  health  problems  may  well  ex- 
amine the  following  table.  A  very  desirable  addition  to 
such  study  would  be  (i)  to  get  a  free  copy  of  the  latest 
Mortality  Statistics  from  the  United  States  Census  Bureau, 
and  (2)  to  get  the  local  reports  of  the  boards  of  health  of  the 
community  and  State.  Any  careful  study  of  such  data  will 
immediately  raise  in  the  mind  of  an  intelligent  and  socially 
minded  student  and  health  worker  the  national  and  school- 
health  problem.  What  can  we  do  to  prevent  these  terrible 
and  largely  unnecessary  losses? 

Illness  and  Physical-Defects  Losses. — According  to  the 
best  obtainable  data,  about  3,000,000  persons  in  the  United 
States  are  constantly  seriously  ill.  Their  illness  causes  loss 
of  wages  to  a  computable  number,  lowered  vitality,  and  fre- 
quently death.  These  illnesses,  largely  and  increasingly  pre- 
ventable, cause  further  enormous  economic  losses  not  computed 
under  deaths,  which  I  have  estimated,  using  Professor  Fisher's 
and  insurance  methods,  as  about  another  billion  dollars  an- 
nually. The  losses  in  happiness,  the  evil  effects  of  breaking 
up  homes,  and  all  such  losses  of  a  personal,  human,  and 
psychological  character  are,  of  course,  beyond  computation. 
From  these  serious  illnesses  and  the  additional  ph3Asical  de- 
fects and  minor  illnesses  comes  more  or  less  directly  a  large 
portion  of  the  most  serious  blots  upon  civilization,  such  as 

'  1910  U.  S.  Mortality  Statistics. 


lO 


EDUCATIONAL  HYGIENE 


TABLE  I 

Causes  of  Death  for  the  Registration  Area,  1910 ' 


All  Causes. 


I.  Gnieral  diseases 

1.  Typhoid  fever 

2.  Malaria 

3.  Smallpox 

4.  Measles 

5.  Scarlet  fever 

6.  Whooping  cough 

7.  Diphtheria  and  croup 

8.  Influenza 

g.  Cholera  nostras 

10.  Dysentery 

I I .  Erysipelas 

12.  Other  epidemic  diseases. . . . 

13.  Purulent  infection,  etc 

14.  Rabies 

15.  Tetanus 

16.  Pellagra 

17.  Tuberculosis  (of  lungs) 

18.  Tuberculosis  (other) 

19.  Rickets 

Syphilis 

Gonococcus  infection 

Cancer  and  other  m.  tumors 
Other  tumors 

24.  Acute  articular  rheumatism 

25.  Diabetes 

26.  Leuchemia 

27.  Anemia,  chlorosis 


20. 


23- 


28.  Other  general  diseases. 


Nervous  sys. — special  sense 

Encephalitis 

Meningitis 

Spinal  cord,  other  dis 

.\poplexy,  cereb.  hem 

Paralysis,  without  sp.  cause 

Epilepsy 

Convulsions  (nonpuerperal) 
Chorea,  St.  Vitus's  dance  . . 
Nervous  system,  other  d . .  . 
Ear  diseases 


Circulatory  system 

Pericarditis 

Endocarditis,  acute 

Organic  d.  of  the  heart 

Angina  pectoris 

Embolism  and  thrombosis . 
Lymphatic  system,  dis.  .  . 


All 
ages 


805,412 

215,692 

12,673 

1,167 

202 

6,598 

6,255 

6,146 

11,521 

7,774 

536 

3.446 

2,442 

198 

1,877 

64 

1,373 

368 

73,214 

13,095 

455 

3,221 

197 

41,039 

553 

3,328 

8,040 

864 

2,614 

5,014 

77,991 

761 
7,619 
4,101 
39,701 
7,756 
2,287 

200 

123 
2,069 

967 

100,106 

650 

4,792 

76,178 

3,869 

1,990 

255 


CHILDREN  OF  SCHOOL  AGES 


17,943 

8,891 

684 
58 

6 

S88 

1,731 

228 

2,938 

122 

14 

47 

8 

23 

73 

13 

162 

4 

489 

933 

13 

24 

83 
9 

327 

144 

44 

39 

4 

1,368 

34 
683 
264 
47 
27 
79 
54 
13 
70 
92 

999 

32 

203 

716 

7 

20 

14 


10-14 


11,736 

4,978 

854 

40 

6 

152 

442 

17 

700 

73 

8 

IS 

14 

II 

62 

9 

IS3 

5 

1,048 

586 

8 

II 

I 

76 

4 

357 

206 

35 

40 

10 

889 

37 

365 

146 

46 

21 

118 

9 

18 

58 

64 

1,319 

32 

226 

1,011 

12 

19 

9 


19,772 

9,770 

1,681 

67 

17 

112 

232 

10 

228 

119 

7 

13 

35 

3 

86 

6 

88 

12 

S,i66 

933 

4 

36 

17 

152 

6 

261 

258 

39 

70 

67 

976 

39 

294 

130 

103 

29 

172 

18 

41 

63 

46 

1,447 

14 

196 

1,158 

17 

33 

9 


Total 
5-1 4 


29,679 

13,869 

1,537 


740 
2,173 

245 
3,638 

19s 
22 
62 
22 
34 

135 
22 

315 

9 

1,537 

1,519 

21 

35 

I 

3 

13 

684 

350 

79 

79 

14 

2,257 

71 

1,048 

410 
93 
48 

197 
63 
31 

128 

156 

2,318 

64 
429 
1,727 
19 
39 
23 


>  Condensed  from  the  table  giving  189  different  causes.  The  registration  area  is 
slowly  enlarging,  hut  in  this  year  included  only  about  three-fifths  of  the  population. 
In  many  of  the  registration  States  the  returns  are  inaccurate,  and  somewhat  incomplete 
("at  least  go  per  cent  of  the  total").  We  are  far  behind  most  European  countries  in 
records  of  both  deaths  and  births. 


PUBLIC   HEALTH   AND   THE   PL^LIC   SCHOOLS 


II 


TABLE  I — Continued 
Causes  of  Death  for  the  Registration*  Area,  1910 


AU 
ages 


IV.  Respiratory  system 

45.  Nasal  fossae  disease 

46.  Larynx,  dis.  of 

47.  Bronchitis,  acute 

48.  Bronchitis,  chronic 

49.  Bronchopneumonia 

50.  Pneumonia 

51.  Pleurisy 

52.  Pulmonary  cong't'n,  p.  ap. 

53.  Other  d.  of  resp.  system. . . 


V.  Digestive  system 

54.  Mouth  and  annexa,  d 

55.  Pharynx 

56.  Ulcer  of  stomach 

57.  Other  d.  of  stomach  (not  c.) 

58.  Diarrhea  and  enteritis 

59.  Appendicitis  and  typhlitis. . 

60.  Hernia 

61.  Intestinal  obstruction 

62.  Other  diseases  of  the  intest. 
03.  Cirrhosis  of  liver 

64.  Other  diseases  of  liver 

65.  Peritonitis  (nonpuerp.)- •  ■  ■ 

66.  Other  d.  of  digestive  system 

VI.  Genitourinary  sys.  nonv 

67.  Nephritis,  acute 

08.  Bright's  disease 

69.  Kidneys,  other  d.  of 

70.  Other  d.  of  uterus 

71.  Salpingitis  and  other  f.  d.. . 


VII.  The  puerperal  slate. 


VIII.  Skin  and  cellular  tissue. 

72.  Gangrene 

73.  Abscess,  acute 


IX.  Bones  and  locomotive  organs 

74.  Bones,  not  t.  b 

75.  Joints,  not  t.  b.  or  rheum. . . 


X.  Malformations 

76.  Hydrocephalus 

77.  Congen.  m.  of  heart . 


XI.  Early  infancy. 

XII.  Oldage 


XIII.  External  causes 

78.  Suicide 

70.  Accidental  or  undefined. 


100,83s 

135 

746 

7,229 

S.391 

25.337 

54.187 

2,150 

24,499 

1. 174 

104,801 

423 

840 

2,203 

8,403 

63.180 

6,128 

2,192 

4,486 

I.57I 

7,485 

3,092 

2,419 

329 

6a,5S9 

5.665 

47.665 

1,389 

774 

1,298 

8,455 

3,008 

1.748 
506 

1,317 

1,145 
119 

7,998 

685 
4,821 

39.388 

13,604 

57,196 

8.590 
45.416 


CHILDREN  OF  SCHOOI,  AGES 


S-9 


2,035 

9 
90 
90 
62 
522 
1,138 
66 
28 
16 

1,669 

II 

123 

13 

116 

469 

571 

8 

127 

25 

15 

36 

132 

9 

S09 

253 

224 

22 


26 


100 

93 
6 


XIV.  IV -defined diseases 12,462 


2,193 
I 

2,161 

74 


956 

9 
13 
21 
30 
148 
664 
32 
17 
13 

1,270 

4 

51 

18 

57 

132 

718 

6 

88 

20 

16 

35 
109 

4 

447 

16s 

263 

6 

5 


36 


25 


1,678 

31 
1,599 

43 


1,517 

5 


36 
158 
1,140 
83 
17 
28 

1.439 
6 
40 
47 
73 
91 

754 
21 

117 
22 
25 
34 

162 

7 

780 

199 

440 

16 

29 

75 

630 

31 

8 
9 


3,024 

326 

2,525 

68 


Total 
S-14 


399 

14 

103 

III 

92 

670 

1,802 

98 

45 

29 

3.939 

15 

174 

31 

173 

601 

1,289 

14 

215 

45 

31 

71 

241 

13 

9S6 

418 

487 

28 

6 

3 


40 

17 
17 

19s 

183 
10 

113 

41 

55 


3.871 

32 
3.760 

117 


GROWTH  OF  THE   REGISTRATION   AREA   FOR   DEATHS, 
1900-1911 

(From  U.  S.  Mortality  Statistics,  191 1) 

Up  to  1880  only  two  States,  Massachusetts  and  New  Jersey,  had  registra- 
tion laws.  ^„^^ 

1900 


I     Mont. 


..  j  N.DAK.  \ 

-,.       /      ^^O;  j    S.DAK.  ! 

/      ^— -T—  .'      ^YO.  I ^— — 

/  r^"7  I 


A 


'  /         ]  A    IOWA   "^        \^^^\      P^' 

\       L__  KANS.         M0.\     M"       >,,yVA^ 

"<.  i  "■-— -vL i^^ssu\.^.\  GA.  ^y/ 

PER  CENT  OF  UNITED  STATES  \  TEXAS  "iL A  i 7     '    ' ^^ ^A 

POPULATION  AREA  ^  •  r^— ""'^'^'^'^^V^/'X 

\ 


Note. — In  addition  to  the  registration  States  (shaded  in  the  cartograms). 
the  registration  area  includes  thirty-eight  cities  in  non-registration  States.  No 
accurate  data  resi)ecting  the  number  and  causes  of  death  in  nearly  half  our 
country  can  yet  be  made.  Laws  requiring  registration  are  of  first  imiiortance 
In  non-registration  States.    The  registration  area  for  births  is  very  much  srnaller. 

I? 


PUBLIC   HEALTH  AND   THE  PUBLIC   SCHOOLS  1 3 

alcoholism   and   poverty.     Devine   estimates   that   not   less  1 
than  one-fourth  of  all  poverty  is  directly  caused  by  illness,  j 
That  from  tuberculosis,  from  the  best  estimates,  seems  to  be 
a  very  large  portion  of  the  whole.    The  lessening  of  tubercu-\ 
losis  means  the  lessening  of  poverty,  and  tuberculosis  pre- 
vention is  very  largely  an  educational  problem.      A  further 
statement  of  the  general  problem  and  the  various  means  of 
solution  may  be  found  in  the  next  chapter. 

In  brief,  then,  we  see  that  the  problem  of  health  is  one  of 
the  most  serious  that  the  country  faces.  The  conservation  of 
our  natural  resources,  such  as  soils,  minerals,  forests,  and 
water-power,  is  a  mere  bagatelle  compared  with  the  problem 
of  the  conservation  of  our  human  resources.  Of  these  we  are 
criminally  wasteful.  While  we  are  making  some  headway  in 
the  control  of  typhoid,  smallpox,  tuberculosis,  the  diseases 
of  infancy,  and  others,  there  has  arisen  in  recent  years 
an  increasing  number  of  degenerative  diseases  in  middle 
life  due  largely  to  ignorance  of  personal  hygiene.^  Such 
increases  tend  to  keep  the  death-rate  as  high  as  it  has  been 
in  the  past. 

The  School  Health  Problem. — While  the  reader  is  passing 
through  this  chamber  of  horrors  and  getting  some  acquaint- 
ance with  a  few  of  the  phases  of  the  health  problem  which 
it  is  necessary  for  us  resolutely  to  face  if  we  are  to  solve  it, 
he  should  obtain  some  glimpse  of  the  evil  effects  of  ill  health 
upon  the  schools,  their  efficiency,  their  pupils,  and  their 
teachers. 

The  death  losses  of  pupils  of  school  age,  whether  in  school 
or  out,  are  enormous  and  largely  preventable.  Undoubtedly 
many  of  these  deaths  are  and  will  continue  to  be  inevitable, 
but  our  success  in  decreasing  the  death-rate  for  many  of  the 
causes  of  death  in  these  ages,  and  many  other  factors,  tends 
to  show  that  the  ratio  established  by  Fisher  of  about  seventy 
per  cent  of  preventabihty  for  these  ages  is  not  too  high. 
*  See  Coleman's  "The  People's  Health,"  p.  228. 


14 


EDUCATIONAL   HYGIENE 


TABLE  II » 

Death-Rates  at  Various  Ages 

"The  following  table  shows  the  changes  in  mortality  that  have  occurred 
in  the  eleven  years  from  1900  to  191 1  in  the  group  of  registration  States  as  con- 
stituted in  1900.  This  area  embraced  about  one-fourth  of  the  total  population 
of  the  United  States  in  19 11  and  hence  the  results  are  of  much  significance 
as  showing  the  general  tendency  of  mortality  for  the  country  as  a  whole." 


AGE  GROUP 

DEATH-RATE  '  PER   1 ,000  POPULATION  FOR  STATES 
INCLUDED  IN  THE  REGISTRATION  AREA  IN  igOO* 

PER    CENT    DEATH- 
RATE   IN  191 1  REP- 

1911 

1900 

IN  igcjo* 

Both 
sexes 

Males 

Fe- 
males 

Both 
sexes 

Males 

Fe- 
males 

Both 
sexes 

Males 

Fe- 
males 

All  ages: 

Crude  rate 

Corrected  rate'. . . 

Under  5  years 

Under  i  year 

I  to  4  years 

5  to  9  years 

10  to  14  years 

15  to  19  years 

20  to  24  years 

25  to  34  years 

35  to  44  years 

45  to  54  years 

55  to  64  years 

65  to  74  years 

75  years  and  over. . . 

14.9 
14.6 

15-8 
iS-3 

14.0 
13-9 

17.2 
17.0 

17.9 
17.6 

16.5 
16. 5 

87 
86 

88 
87 

8S 
84 

36.6 

125-5 

12.8 

3-2 
2.2 

35 
50 

6.3 

9.4 

14-5 

28.4 

58.3 

143 -o 

39-8 

138.6 

133 

3-4 
2.4 

3-7 
5-3 

6.7 
10.4 
16. 1 

309 
61.6 

147.4 

33-3 

112. 1 

12.2 

3-1 
2. 1 

3-3 
4-7 

6.0 

8.3 

12.9 

26.0 

55-1 

139.2 

49.9 

161. 9 

19.8 

4-7 
30 
4.8 
6.8 

8.2 
10.3 
150 
27-3 
56.5 
142.4 

54-1 

178.4 

20.4 

4-7 
2.9 
4.9 
7.0 

8.3 
10.8 
IS. 8 
28.8 
59-5 
145-9 

45-7 

1450 

19. 1 

4.6 
31 
4.8 
6.7 

8.2 

9.8 

14.2 

25.8 

53-7 

139-3 

73 
78 
65 

68 
73 
73 
74 

77 
91 
97 
104 
103 
100 

74 
78 
6S 

72 
83 
76 
76 

81 

96 

102 

107 

104 

lOI 

73 
77 
64 

67 
68 
69 
70 

73 
85 
91 

lOI 

103 
100 

'From  igii  U.  S.  Mortality  Statistics.  =  Exclusive  of  still-births. 

3  Group  includes  Connecticut,  the  District  of  Columbia,  Indiana,  Maine,  Massachu- 
setts, Michigan,  New  Hampshire,  New  Jersey,  New  York,  Rhode  Island,  and  Vermont. 

*The  death-rate  for  1911  for  both  sexes  is  only  87%  of  that  of  1900  and  the  death- 
rate  for  males  greater,  loi  to  107%,  than  in  1900.  Notice  also  that  infant  mortality 
decreased  from  161.9  a  thousand  to  125.5  a  thousand  in  1911. 

'  Based  on  the  standard  million  of  England  and  Wales,  1901. 


Effective  health  education  of  pupils  and  parents,  and  efTect- 
ive  public-health  service,  ought  to  make  possible  an  almost 
complete  extermination  of  a  large  number  of  diseases  in  these 
hardy  age  periods  from  five  to  twenty.' 

•  "One  interesting  and  notable  thing  about  modern  public-health  work  is 
its  tendency  to  supplement  purely  administrative  methods  by  educational 
ones, "— WiNSLOw, 


PUBLIC   HEALTH   AND   THE   PLTELIC    SCHOOLS 


15 


1 

/ 

" 

HISTOGRAM  ILLUSTRATING 

TABLE  II.  DEATH  RATE 
PER   1,000  POPULATION  FOR 
STATES  INCLUDED  IN 
REGISTRATION  AREA 
IN   1900    BOTH   SEXES.   1911. 
Rates  tor  school  aaes;- 
5-9    —  3.2  per  1000 
10-14-  2.2    ••       •• 
15-19-3.5    "       - 

/ 

f 

/ 

120 

no 

i 

r 

/ 

100 

/ 

90 

i 

' 

/ 

/ 

} 

/ 

/ 

/ 

/ 

I 

^ 

y 

Rate  5 

^sj 



n 

^ 

Age  Groups 

0-5 

5-9 

10-14 

15-19 

20-24 

25- 

-34 

35- 

-44 

45- 

-54 

55- 

-64 

65- 

-74 

74  and 

iver 

Note. — The  rate  for  both  sexes  in  1911  for  these  ten  States  is  for  the  infants 
less  than  a  year  old  125.5,  and  for  the  ages  two  to  four  inclusive  only  12.8. 
These  data  do  not  include  still-births.  The  years  ten  to  fourteen  inclusive  seem 
to  be  the  hardiest  years  of  life,  although  the  sickness  rate  is  higher  than  in  cer- 
tain other  age  groups.  The  number  of  deaths  at  the  lowest  part  of  the  curve 
are  as  follows:   5-9 — 18,112.     10-14 — 12,337.     15-19 — 21,154. 

There  are,  however,  in  the  United  States  approximately 
100,000  children  of  elementary  and  high-school  age  who  die 
each  year.  Probably  at  least  60.000  of  these  deaths  were 
unnecessary  losses  {i.  e.,  preventable),  and  50,000,  or  half, 
would  probably  be  a  low  estimate.  In  looking  over  the  death- 
rates  for  various  diseases  in  comparison  with  the  number  of 
cases  of  illness  in  many  cities  it  has  been  found  that  the  num- 
ber of  cases  occurring  and  the  proportion  of  deaths  from  the 
various  ailments  vary  quite  directly  with  the  efficiency  of 
the  public-health  agencies.  Efficient  health  agencies  decrease 
the  number  of  cases  of  illness  and  the  proportion  of  deaths 
from  them.     Many  city  and  State  boards  of  health  print  on 


i6 


EDUCATIONAL  HYGIENE 


TABLE  III 

Showing  the  Preventability  of  Deaths  of  Children  of  Elementary 
School  Age,  5-14,  for  25  Most  Numerous  Causes  of  Death,  iqio 


CAUSES  OF  DEATHS 


Accidents 

Diphtheria  and  croup. . . 

Scarlet  fever 

Pneumonia 

Heart,  organic  disease. . . 

Typhoid  fever 

Tuberculosis  of  lungs 

Tuberculosis,  other 

Appendicitis 

Meningitis 

Measles 

Rheumatism,  articular. . 

Bronchopneumonia 

Diarrhea  and  enteritis. . . 
Bright's  disease,  kidneys. 

Endocarditis,  heart 

Nephritis,  acute,  kidneys 

Spinal  cord,  others 

Diabetes _ 

Tetanus,  lockjaw 

Whooping-cough 

Peritonitis 

Intestinal  obstruction  — 

Epilepsy 

Influenza,  grippe 


No.  deaths 
in  registra- 
tion area 


3-760 

3,638 

2,173 

1,802 

1,727 

1,537 

1,537 

1,519 

1,218 

1,048 

740 

684 

670 

601 

487 

429 

418 

410 

350 

315 

245 

241 

215 

197 
195 


26,227 


Per  cent 

pre- 
ventable 


70 
SO 
45 
25 
85 
75 
75 
50 
70 
40 
10 
50 
60 
40 
25 
30 


80 
40 
55 
25 

50 


67> 


Total  No. 
deaths  in 
the  U.  S. 


6,300 

6,200 

3,700 

3.050 

3,000 

2,600 

2,600 

2,560 

2,160 

1,600 

1,250 

1,150 

1,140 

1,020 

820 

730 

700 

690 

•   500 

530 

410 

400 

390 

330 

330 


44,270' 


No.  pre- 
ventable 
deaths 


4,340 

1,850 

1,370 

7SO 

2,210 

1,950 

1,920 

1,080 

1,120 

500 

116 

S70 

612 

328 

182 

210 

"60 
424 
164 
220 
97 

82 


20,155 


Total  number  of  deaths,  5-14,  in  registration  area,  29,679. 
Total  number  of  deaths,  5-14,  in  the  United  States,  about  50,000. 
Total  number  deaths  preventable,  about  33,500.     Based  upon  1910  U.  S.  Mortality 
Statistics  and  Fisher's  Preventability  Tables. 


>  Fisher's  average. 


» Estimated. 


their  various  bulletins  these  significant  words:  "Public  health 
is  purchasable.  Within  natural  limitations  a  community 
can  determine  its  own  death-rate."  And  the  prophecy  of 
Pasteur  has  in  some  communities  gone  far  toward  realization : 
namely,  that  "it  is  within  the  power  of  man  to  rid  himself 
of  every  parasitic  disease." 

'The  economic  losses  due  to  the  cost  of  educating  for  several 
years  in  public  schools  the  children  who  die  in  this  period  are 
of  course  a  large  source  of  public  preventable  waste. 


PUBLIC   HEALTH  AND   THE   PUBLIC    SCHOOLS 


17 


TABLE  IV 

Showing  the  Preventability  of  Deaths  of  Children  of  High-School 
Age,  15-19,  for  25  Most  Nuaierous  Causes  of  Death  in  1910 


CAUSES  OF  DEATHS 


No.  deaths 
in  registra- 
tion area 


Per  cent 

pre- 
ventable 


Total  No. 
deaths  in 
the  U.  S. 


No.  pre- 
ventable 
deaths 


Pulmonary  tuberculosis. . . 
Accidents  and  undefined . . 

Typhoid  fever 

Heart-disease,  organic. . . . 

Pneumonia 

Tuberculosis,  other  parts. . 

Appendicitis 

Bright's  disease 

Suicide 

Meningitis 

Rheumatism,  articular 

Diabetes 

Scarlet  fever 

Diphtheria  and  croup 

Nephritis,  acute 

Endocarditis  (heart) 

Epilepsy 

Peritonitis 

BronchopneiHnonia 

Cancer  and  other  tumors. . 
Spinal  cord,  other  diseases 

Influenza,  grippe 

Intestinal  obstruction 

Measles 

Apoplexy,  cerebral  hem. . . 


S.166 
2,525 
1,681 
1. 158 
1,140 
933 
754 
440 
326 
294 
261 
258 
232 
228 
199 
196 
172 
162 
158 
152 
130 
119 
117 
112 
103 


75 


25 
45 
75 
50 
40 

70 


SO 
70 
30 
25 

55 
50 


50 
25 
40 

35 


17,016 


67> 


8,650 

4,230 

2,830 

1,940 

1,920 

1,750 

1,270 

740 

550 

500 

450 

450 

400 

400 

340 

340 

300 

280 

280 

260 

220 

200 

200 

190 


28,780 


6,487 

2,405 
48s 
864 

1,177 
635 
2  86 

350 
45 
45 
200 
280 
102 
85 

154 
140 


100 
50 
76 
63 


14,039 


Total  number  of  deaths,  15-19,  in  registration  area,  19,772. 
Total  number  of  deaths,  15-19,  in  the  United  States,  about  34,000. 
Total   number  of  deaths,    15-19,   preventable,  about   24,100.     Based  upon   1910 
U.  S.  Mortality  Statistics  and  Fisher's  Preventability  Tables. 

1  Fisher's  average  for  all  causes  of  death. 


The  illness  and  physical-defects  losses  of  both  teachers 
and  pupils  of  the  public  schools  are  enormous,  coming  in  the 
form  of  personal  and  public  financial  loss,  of  lowered  vital 
efiiciency  and  happiness,  and  of  elimination,  non-promotion, 
and  retardation  at  school. 

Combined,  the  physical-defects  and  illness  losses  are  very 
great  but  as  yet  hardly  computable.  Ayres,  Cornell,  -and 
others  have  given  good  reason  to  beHeve  from  their  investi- 
gations that  a  large  share  of  retardation  is  due  to  physical 


i8 


EDUCATIONAL   HYGIENE 


TABLE  V 

Approximate  Expectation  of  Life  in  a  State  that  Has  Kept  Life 
Statistics  for  Several  Years  ' 


MASSACHUSETTS  (WHITE) 

SIX  YEARS 

1900 

I 

884-1890 

1880 

Males 

Fe- 
males 

Per- 
sons 

Males 

Fe- 
males 

Per- 
sons 

Males 

Fe- 
males 

Per- 
sons 

0.  .  . 

44-29 

47-80 

46.0s 

40.39 

42.59 

41.49 

44.06 

45.22 

44.64 

I . . . 

53-13 

54.96 

54.05 

49.29 

50.40 

49 -8s 

51.18 

51.20 

51.19 

2.  .  . 

54-64 

56-28 

55.46 

52.13 

53-15 

52-64 

53.30 

53.06 

53.18 

3--  • 

54-69 

56-31 

55.50 

52.37 

53-45 

52.91 

53.88 

53.60 

S3. 74 

r     4... 

54-42 

55-97 

55.20 

52.20 

53-29 

52.75 

54.05 

53.75 

53.90 

s--  • 

53-90 

55   50 

54   70 

51-93 

53-02 

52-48 

53.92 

53.67 

53.80 

10. . . 

SO-15 

51-70 

50.93 

48.83 

49-97 

49.40 

51.01 

50.93 

50.97 

IS-.- 

45-79 

47-49 

40.64 

44-78 

45-98 

45-38 

46.8s 

46.86 

46.86 

1-  20.  .  . 

41-79 

43-54 

42.67 

41.09 

42-42 

41.76 

43.09 

43.49 

43.29 

25.  .  . 

38.23 

39-71 

38.97 

37.79 

39-04 

38.42 

39.81 

40.44 

40.13 

30..  . 

34-66 

36.07 

35. 37 

34.50 

35-76 

35-13 

36.38 

37. 28 

36.83 

35-  •  • 

31-09 

32.42 

31.76 

31.20 

32.48 

31.84 

32.96 

34.13 

33.55 

40.  .  . 

27.49 

28.79 

28.14 

27.86 

29.17 

28.52 

29.48 

30.78 

30.13 

45-  •  • 

23.89 

25.16 

24.53 

24.51 

25-86 

25.19 

26.01 

27 -43 

26.72 

SO.  .  . 

20.57 

21.74 

2  1.  16 

21.33 

22.56 

21.95 

22.52 

23.93 

23.23 

55-  •  ■ 

17-25 

1S.32 

17-79 

18. IS 

19   25 

18.70 

19. oi 

20.43 

19.73 

60 .  .  . 

14-48 

15.41 

1495 

15. 35 

16.32 

15.84 

15.98 

17.26 

16.62 

65... 

T  1  .  70 

12.50 

12.  10 

12.54 

13-38 

12.96 

12.95 

14.08 

13.52 

70.  .  . 

9-69 

10.31 

10.00 

10.38 

11-03 

10.71 

10.63 

11.60 

II  .12 

75-  •  • 

7.68 

8.12 

7.90 

8.21 

8.68 

8.45 

8.31 

9.13 

8.72 

80.  .. 

6-57 

6.83 

6.70 

6.QI 

7-17 

7.04 

7.06 

7.62 

7.34 

85... 

5.46 

5.54 

5 -50 

5.60 

5.66 

5.63 

5.82 

6.12 

5.97 

yo.  .  . 

3-98 

4.02 

4.00 

95-  ■  . 

2.50 

2.50 

2.50 

The  school  ages  are  bracketed  at  the  left.  In  Massachusetts  a  "person"  four  years 
of  age  in  1884-90  would  probably  live  fifty-three  years  longer  (52.75);  in  1880  his 
chances  were  extended  to  fifty-four  years,  and  in  1900  to  fifty-five  years.  Recent  health 
improvements  have  probably  raised  it  to  fifty-six  years. 

1  From  Bulletin  15  of  the  United  States  Bureau  of  the  Census,  entitled  "A  Dis- 
cussion of  the  Vital  Statistics  of  the  Twelfth  Census." 

defects  and  the  absence  and  illness  caused  by  them.-  I  have 
shown  that  perhaps  25  per  cent  or  more  of  all  absences  from 
school  is  caused  by  illness  and  that  absence  is  a  very  large 

"  See  chapter  on  "  Physical  Defects  and  School  Progress"  in  the  last  edition 
of  "Medical  Inspection  of  Schools,"  and  the  appendix  in  this  volume. 


PUBLIC   HEALTH   AND   THE   PUBLIC   SCHOOLS 


19 


TABLE  VI 

Approximate  Expectation  of  Life  in  Another  State  that  has  Kept 
Life  Statistics  for  Several  Years  ^ 


NEW  JERSEY  (WHITE) 

AGE 

1900 

SIX  YEARS 
1884-189O 

1880 

Males 

Fe- 
males 

Per- 
sons 

Males 

Fe- 
males 

Per- 
sons 

Males 

Fe- 
males 

Per- 
sons 

0.  .  . 
I  .  .  . 
2.  .  . 
3--- 

r    4... 

5..- 
1  10. . . 

i5--- 
'-20. . . 

25... 

30-.  - 
35--- 
40... 

45--- 
50-.- 

55  •■  •  - 
60... 
6s... 
70... 
75- •• 

80... 
85... 
90.  .  . 
95.- 

44.06 
52.0s 
53  63 
53-75 
53-39 

52.86 
49.27 
45-00 
41.04 
37.38 

33.84 
30.29 
26.87 
23-44 
20.18 

16.92 
14.19 
11.46 
9.52 
7.58 

6.47 
5-35 
3-93 
2-50 

48-27 
54-45 
56.07 
56-06 
55-77 

55-28 
51-59 
47-24 
43-12 
39-35 

35-79 
32.22 
28.67 
25.11 
21.64 

18.17 
15.23 
12.28 
10. 16 
8.03 

6.83 
S.62 

4.06 
2.50 

46.17 
53-25 
54-85 
54-91 
54  58 

54 -07 
50-43 
46.12 
42.08 
38.37 

34.82 
31.26 
27-77 
24.28 
20.91 

17.55 

14.71 

11.87 

9.84 

7.81 

6.65 
5-49 
4.00 
2.50 

40.  II 
48.73 
51-66 
52-00 
52-04 

51-79 
48.62 

44-55 
40.72 
37.36 

34.05 
30.73 
27.46 
24.18 
20.97 

17.76 

14.91 

12. OS 

9.94 

7.83 

6.71 
S-58 

43-55 
51-08 
53.81 

54-22 

54-25 

53-96 
50-82 
46.79 
43.09 
39-57 

36-18 
32-78 
29-37 
25-95 
22-54 

19-13 
16.09 
13.05 
10.71 
8.37 

7-07 
S-77 

41-83 
49.91 
52-74 
53-11 
53-15 

52-88 
49-72 
45-67 
41.91 
38.47 

35.12 
31.76 
28.42 
25  07 
21.76 

18.45 
15.50 
12.55 
10.33 
8.10 

6.89 
5.68 

45.59 
52.65 
54-39 
54-94 
54-94 

54-71 
51-57 
47-36 
43-29 
39-80 

36.26 
32.71 
29.20 
25.70 
22.33 

18.96 
16.10 
13-25 
10.90 
8-54 

7.40 
6.26 

48.0s 
54-23 
55-71 
56-13 
56.03 

55-66 
52-52 
48.40 
44-51 
41-15 

37-76 
34-37 
30.80 
27.24 
23.70 

20.15 
16.89 
13-63 
II. 12 
8.60 

7-36 
6.13 

46.82 
53-44 
55-05 
55-54 
55-49 

55 -19 
52.05 
47-88 
43-90 
40.48 

3701 

33-54 
30.00 
26.47 
23-02 

19.56 
16.50 

13.44 

II  .01 

8.57 

7.38 
6.20 

The  school  ages  are  bracketed  at  the  left. 

iFrom  Bulletin  15  of  the  U.  S.  Bureau  of  the  Census,  entitled  "A  Discussion  of 
the  Vital  Statistics  of  the  Twelfth  Census." 


factor  in  causing  retardation.  Absence  has  a  proved  correla- 
tion with  non-promotion,  and  illness  is  the  chief  cause  of  ab- 
sence, especially  the  longer  absences.  Experiments  carried  on 
by  Wallin  in  Cleveland  and  by  Kohnky^  in  Cincinnati 
seem  to  indicate  that  mere  dental  hygiene  has  probably  a 
decidedly  favorable  efTect  on  the  mental  and  physical  status 
^  Kohnky,  Journal  of  Educational  Psychology,  December,  1913. 


20  EDUCATIONAL  HYGIENE 

of  school-children.  In  the  Cincinnati  investigation  a  control 
class  was  used  and  the  results  seem  to  show  a  direct  causal 
relationship  between  mouth  hygiene  and  school  progress. ^ 
Doctors  and  nurses  and  teachers  of  the  public  schools  where 
medical  supervision  is  carried  on  are  unanimous  in  their 
[opinion,  based  on  observation,  that  school  progress  for  very- 
many  children  is  materially  hastened  by  the  ehmination  of 
'their  physical  defects  and  the  cure  of  their  ailments. ^ 

My  own  studies  of  the  rough  data  gathered  in  a  survey 
of  a  number  of  cities  seem  to  indicate  that  not  less  than  about 
15  per  cent  of  elimination,  16  per  cent  of  non-promotion,  and 
17  per  cent  of  retardation  is  caused  by  the  illnesses  and  phys- 
ical defects  of  school-children.  We  are  not  yet  ready  to  state, 
in  general  nor  for  any  one  city,  precisely  how  much  an  aid 
to  school  progress  and  community  health  medical  supervision 
and  the  various  phases  of  educational  hygiene  are.  The  behef 
is  warranted  that  they  are  great.  Before  accurate  measure- 
ments can  be  made  we  must  have  very  much  more  accurate 
statistical  records  and  reports  and  much  improved  super- 
vision by  health  speciaHsts.  Records  and  reports  at  the  pres- 
ent time  are  entirely  too  vague,  variable,  and  meaningless 
for  any  accurate  knowledge  of  school  health  work.  In  a 
later  chapter  on  medical  supervision  I  give  a  tentative  stand- 
ard plan  for  the  administration  of  educational  hygiene,  es- 
pecially of  medical  supervision,  and  offer  there  for  criticism 
and  use  a  tentative  standard  terminology  and  classification 
of  the  multitudinous  ailments  of  school-children.  There  it 
will  be  seen  that,  according  to  the  best  data  obtainable,  not 
far  from  one-third  of  the  school-children  will,  on  the  average 
and  in  any  one  school  year,  be  found  to  suffer  from  no  ail- 
ments of  a  serious  nature,  one-third  with  teeth  defects  only, 
one-third  with  teeth  defects  and  two  or  more  other  ailments  each} 

'  Wallin,  Dental  Cosmos,  April,  1913. 

'See  articles  in  the  Psychological  Clink  for  January,  1915. 

'See  the  writer's  survey  of  Rural  School  Hygiene  in  the  Report  on  Rural 
Schools  to  the  Pennsylvania  State  Educational  Association,  19  4,  State  Supt. 
N.  C.  Schaeffer,  Harrisburg,  Pa.,  Chairman. 


PUBLIC   HEALTH  AND   THE   PUBLIC   SCHOOLS  21 

These  facts,  then,  set  forth  rather  vaguely  and  inadequately 
the  school  health  problem.  About  half  of  the  school- children 
mjiy  be  said  to  be  seriously  aihng  and  defective  in  any  one 
school  year  and  in  grave  need  of  the  care  of  school  doctors, 
nurses,  dentists,  physical-training  teachers,  and  others.  The 
need  is  for  efl&cient  agencies  for  discovering  the  exact  health 
status  of  the  pupil  population,  the  health  census,  and  then 
for  further  efficient  agencies  for  preventing  such  ailments  and 
for  getting  cured  and  corrected  those  found  to  exist.  Un- 
doubtedly this  work,  if  well  carried  on,  will  place  the  school 
in  close  and  intimate  association  with  the  home,  the  pubUc- 
health  agencies,  the  private  organizations  that  may  be  in- 
terested in  health  advancement,  and  with  the  real  life  of  the 
city  or  community.  This  is  a  consummation,  of  course,  de- 
voutly to  be  wished.  The  following  chapters  give  the  latest 
word  of  a  number  of  leading  specialists  on  the  various  ways 
and  means  by  which  school  systems  may  markedly  influence 
the  life  of  the  times  by  increasing  the  health  and  happiness  of 
our  people. 


CHAPTER  II 

THE  PUBLIC-HEALTH  MOVEMENT 

Public  Health  and  Public  Welfare.— ^Public  health  is  the 
I  most  fundamental  and  basic  element  of  social,  economic, 
I  and  national  efficiency.  Wealth  is  but  a  symptom  and  func- 
tion of  health.  Yet  with  our  innate  inclination  to  consider 
symptoms  rather  than  to  grapple  with  fundamental  causes, 
we  have,  in  our  systems  of  social  philosophy,  either  entirely 
left  out  the  element  of  public  health  or  given  to  it  but  pass- 
ing attention.  We  have  developed  an  immense  science  of 
economics  and  a  philosophy  of  wealth,  but  have  left  the  science 
of  public  health  in  a  very  fragmentary  and  incomplete  state. 
With  the  recently  awakened  active  interest  in  the  promotion 
of  public  health  the  need  of  scientifically  established  principles 
is  becoming  very  acute,  but  with  reference  to  understanding 
public-health  needs  we  are  in  a  state  of  almost  complete  chaos. 
During  the  winter  session  of  the  various  State  legislatures, 
for  example,  about  one  thousand  bills  on  public  health  were 
considered,  ranging  in  importance  from  reorganizing  whole 
State  departments  of  health,  or  passing  model  vital-statistics 
laws,  to  the  prohibition  of  roller  towels.  Some  of  the  measures 
are  insignificant,  others  unnecessary,  while  still  others  exhibit 
the  propensity  merely  to  follow  certain  styles  or  fashions. 
Doctor  Frederick  R.  Green,  the  secretary  of  the  Council  on 
Health  and  Public  Instruction,  of  the  American  Medical  As- 
sociation, commenting  on  such  floods  of  bills,  says  that  they 
disclose  "a  tendency  on  the  part  of  the  legislatures  to  follow 
prevailing  fads  in  lawmaking."  ^ 

"The    public-health   movement   to-day   is   going   almost 
'  The  Survey,  September  27,  1913,  p.  748. 


THE   PUBLIC-HEALTH   MOVEMENT  27, 

too  fast,"  says  Professor  Sedgwick/  "almost  faster  than  the 
teachers  and  directors  of  the  movement  could  wish,  because 
a  great  many  foohsh  things  are  being  done  to-day  in  the  name 
of  public  health,  and  there  are  public-health  fakirs  as  there 
are  quacks  and  dealers  in  quackeries." 

Since  the  interest  in  public  health  has  gained  such  an 
impetus,  and  since  so  much  activity  is  being  displayed  by 
governmental,  civic,  and  private  organizations,  it  becomes 
imperative  to  see  that  the  movement  is  directed  along  proper 
channels  in  order  that  an  unnecessary  waste  of  energy  and 
money  may  be  prevented  and  that  the  fragments  of  public- 
health  science  may  be  woven  into  a  coherent  entity  for  the 
guide  of  legislators  and  public-health  administrators. 

At  this  stage  of  the  movement  it  is  necessary,  therefore, 
to  take  stock  of  the  methods  used,  of  the  forces  at  work,  and 
of  the  achievements  accomplished.  It  is  a  tremendous  task 
and  the  present  paper  is  but  an  elementary  attempt  to  state 
the  problem. 

Preventive  Medicine. — The  foundations  and  possibilities 
of  this  great  health  movement  lie  largely  in  preventive 
medicine.  "Although  drugs  are  helpful  to  the  individual  in 
that  they  may  lessen  his  suffering  and  hasten  his  recovery, 
they  are  of  no  avail  in  preventing  disease  in  a  population. 
Take  the  best-established  cures  in  medicine,  the  drugs  known 
as  'specifics' — -iron  in  anemia,  mercury  in  syphilis,  quinine 
in  malaria,  antitoxin  in  diphtheria  and  tetanus — and  who  can 
say  that  they  have  exerted  the  slightest  effect  upon  the  in- 
cidence of  these  diseases  in  human  communities?  On  the 
other  hand,  see  what  preventive  medicine  has  accompKshed 
in  combating  puerperal  and  surgical  fevers,  smallpox,  malaria, 
yellow  fever,  rabies  (in  England  it  no  longer  occurs) ,  Mediter- 
ranean fever,  plague,  and  relapsing  fever.  .  .  .  Many  hun- 
dreds of  thousands  of  lives  throughout  the  world  are  now 

'  "The  Public  Health  Movement  in  America — To-day  and  To-morrow," 
an  address  delivered  before  the  Association  of  Life  Insurance  Presidents, 
December,  1913. 


24  EDUCATIONAL  HYGIENE 

saved  annually  by  preventive  medicine."^  And  preventive 
medicine  is  but  in  its  infancy.  Its  possibilities  are  immeas- 
urable. With  every  new  medical  discovery  new  possibilities 
arise.  The  foundation  of  the  public-health  movement  has 
already  become  enormous  and  it  is  widening  from  day  to  day. 

The  Aims  of  the  Public-Health  Movement. — The  public- 
health  movement  may  be  broadly  defined  as  a  social  effort 
to  prevent  disease,  to  lengthen  the  life  and  usefulness  of  every 
member  of  society,  and  to  afford  opportunities  for  a  normal 
physical  and  mental  development  of  society. 

In  its  broad  aspects  public-health  work  consists  in  pre- 
venting preventable  diseases  by  means  of  early  diagnosis  and 
efficient  quarantine,  in  affording  opportunities  for  effective 
treatment  and  cure  of  the  sick,  in  combating  filth,  un- 
hygienic living,  insanitary  conditions  of  work  and  habita- 
tion, in  health  education  of  individuals  and  communities,  and 
in  providing  opportunities  for  sunhght,  fresh  air,  pure  food, 
and  recreation.  Each  of  these  main  branches  divides  itself 
into  a  great  number  of  constituent  elements.  I  shall  not 
even  attempt  to  enumerate  them  but  shall  indicate  some  of 
the  results  already  obtained  and  some  of  the  problems  to  be 
attacked. 2 

Prolongation  of  Life. — It  has  been  estimated  with  more 
or  less  accuracy  that  the  average  length  of  human  life  in  the 
sixteenth  century  was  between  eighteen  and  twenty  years, 
and  at  the  end  of  the  eighteenth  century  was  a  little  over 
thirty  years;  while  to-day  it  varies  in  different  countries  from 
less  than  twenty-five  to  more  than  fifty  years.  The  general 
death-rate  of  the  city  of  Berlin  has  been  reduced  from  32.9 
per  1,000  in  1875  to  16.4  in  1904,  and  to  14.7  in  1910.  The 
death-rate  of  London  has  decreased  from  20.9  for  the  four- 
year  period  of  188 1-5  to  12.7  in  19 10;    for  the  same  period 

'  Professor  Geo.  N.  F.  Nuttall,  of  Cambridge,  England,  "Proceedings  of  the 
Fifteenth  International  Congress  of  Hygiene  and  Demography,"  vol.  IV,  part 
2,  p.  417. 

*See  Devine's  "Seventeen  Health  Demands"  in  The  Survey  for  July  4,  1914. 


THE  PUBLIC-HEALTH  MOVEMENT 


25 


Dublin  shows  a  decrease  from  27.5  to  19.9,  Amsterdam  from 
25.1  to  12.4,  Stockholm  from  24.3  to  14.6,  New  York  from 
27.5  to  15. 1  in  1911,  Chicago  from  21.5  to  14.6,  and  so  along 
the  line.  The  average  death-rate  in  the  whole  of  the  regis- 
tration area  of  the  United  States  has  decreased  from  17.6  in 
19C0  to  14.2  in  1911.  While  the  average  death-rate  all  over 
the  civilized  world  has  for  the  last  quarter  of  a  century  been 
constantly  declining,  the  chief  gains  in  saving  life  have  been 
made  at  the  beginning  of  the  course,  in  the  younger  age  groups. 
The  death-rate  in  the  later  age  groups,  above  forty,  has  been 
constantly  increasing.^ 

The  following  is  a  table  showing  the  death-rates  for  males 
and  females,  by  age  groups,  for  the  years  1900  and  191 1  re- 
spectively, for  the  registration  States  as  they  were  constituted 
in  the  year  1900.2 

COMPARISON  OF  MORTALITY  OF  MALES  AND  FEMALES  BY  AGE 

GROUPS 
Death-Rates  per  1,000  Population 


AGE 

MALES 

FEMALES 

1900 

igii 

Per  cent 

increase  or 

decrease 

1900 

1911 

Per  cent 

increase  or 

decrease 

Under  5 

5-9 

10-14 

15-19 

20-24 

25-34 

35-44 

45-54 

55-64 

65-74 

75  and  over. 

54 
4 
2 

4 

7 

8 

10 

15 

28 

59 

146 

2 
7 
9 
9 
0 
3 
8 
8 
9 
6 
I 

39 

3 

2 

3 

5 

6 

10 

16 

30 

61 

147 

8 
4 
4 
7 
3 
7 
4 
1 

9 

6 

4 

-26.57 
—  27.66 
-17.24 

-24-49 
-24.29 
-19.28 
+  370 
+  1.90 
+  6.92 
+  336 
+  0.89 

45 

4 

3 

4 

6 

8 

9 

14 

25 

53 

139 

8 
6 

1 
8 
7 
2 
8 
2 
8 
8 
5 

33-3 
3-1 
2.1 
3-3 
4-7 
6.0 
8.3 
12.9 
26.0 

55 -r 
139.2 

-27.29 

-32.61 

-32.26 

-31-25 

-29.8s 

-26.83 

-1S-31 

-9-15 

+  0.78 

+  2.42 

—  0.22 

All  ages 

17.6 

15-8 

—  10.23 

16.5 

14.0 

-15-15 

From  this  table  one  can  readily  see: 

I.     That  men's  chances  for  longevity  are  considerably 

iSeeTablesII,  V,  VI. 

*  Table  quoted  by  Louis  I.  Dublin,  in  American  Journal  of  Public  Health, 
December,  1913,  p.  1263. 


26 


EDUCATIONAL  HYGIENE 


poorer  than  women's,  and  that  the  reduction  in  the  mortality 
rates  has  benefited  women  more  than  men;  and 

2.  That  the  mortahty  rates  for  males,  in  191 1,  exhibit  a 
tendency  to  increase,  beginning  with  the  age  group  of  from  45 
to  54,  and  of  women  with  the  age  group  from  55  to  64.  These 
increases  in  death-rates  after  45  are  chiefly  due  to  the  so-called 
degenerative  diseases  (including  apoplexy,  paralysis,  and  the 
diseases  of  the  heart,  circulatory  system,  kidneys,  and  liver). 
Mr.  Rittenhouse,  of  the  Life  Extension  Institute,  has  compiled 
the  following  comparative  table  of  these  diseases,  for  the  years 
1880  and  1909,  for  Massachusetts:^ 


DEATH-RATES  FOR  DEGENERATIVE  DISEASES  PER  I0,000 
POPULATION 


Ages 

All 

Under  5 

5-9 

10-14 

IS-IQ 

20-29 

30-39 

40-49 

SO-S9 

6o-6g 

70  and  over 


1880 


23.21 

7.92 

2.91 

2.85 

3   10 

4-95 

10.13 

19.70 

3901 

102.05 

261 . lO 


43.26 


37 
91 

21  2 
558 


Per  cent  of 
increase 


86.38% 

30.8 
35-7 
65.6 
75-2 
63 -4 
85.5 
92.1 
1340 


113. o 


It  can  be  seen  in  the  right-hand  column  that  the  great 
increases  are  for  persons  over  forty,  and  above  that  age 
the  increase  from  1880  to  1909  is  from  about  23  to  43  per 
cent. 

Another  disease  deserving  consideration  in  this  connection 
is  cancer.  Approximately  75,000  deaths  annually  are  at- 
tributed to  this  disease  in  the  United  States,  and  the  indica- 
tions are  that  a  steady  increase  of  the  death-rate  from  cancer 
is  taking  place  in  this  country  at  ages  over  forty-five.  Cancer 
is  now  of  even  greater  importance  than  tuberculosis.  Whether 
^Popular  Science  Monthly,  April,  1913,  pp.  376-380. 


THE   PUBLIC-HEALTH  MOVEMENT  27 

this  rise  of  cancer  is  a  result  of  a  better  recognition  of  the 
disease  or  whether  it  is  a  real  rise  cannot  as  yet  be  definitely 
determined.  But  there  is  a  great  possibihty  for  prevention 
of  the  disease  by  education  and  proper  diagnosis  in  the  early 
stages.  Recently  a  national  society  has  been  formed  for  this 
purpose. 

The  very  large  increase  in  the  death-rates  from  these 
diseases,  particularly  noticeable  in  the  age  groups  above  forty, 
is  a  sad  commentary  upon  our  civilization.  The  wear  and 
tear  of  modern  life,  the  nervous  strain  and  high  tension  to 
which  we  are  all  subjected,  ill  adaptation  to  changing  con- 
ditions, unsound  habits  of  Hfe,  and  the  pernicious  after-effects 
of  the  diseases  of  childhood,  youth,  and  middle  age  are  re- 
sponsible for  this  disquieting  phenomenon. 

How  Hving  habits  affect  mortaUty  is  strikingly  demon- 
strated by  the  experience  of  the  United  Kingdom  Temperance 
and  General  Provident  Institution,  described  by  Doctor  E.  L. 
Fisk.^  According  to  the  records  of  the  above-mentioned  in- 
stitution, "two  large  bodies  of  hves,  almost  equal  in  numbers, 
and  homogeneous  except  for  the  use  of  alcohol,  moved  along- 
side of  each  other  for  forty  years,  and  the  group  of  abstainers 
at  all  times  exhibited  a  markedly  superior  \'itaHty  to  the 
other  group,  the  non-abstainers,  the  total  difference  in  favor 
of  the  abstainers  during  the  period  covered  being  27.4  per 
cent,  although  the  mortahty  among  the  general,  or  non- 
abstaining,  class  was  only  91  per  cent  of  that  expected  ac- 
cording to  the  British  O™  Table,  representing  the  experience 
of  sixty-three  British  officers."  We  have  no  similarly  direct 
statistical  evidence  on  the  effects  upon  the  death-rate  of 
bad  housing  conditions,  insanitary  working  conditions,  lack 
of  school  medical  supervision,  lack  of  health  education,  etc. 
We  know,  however,  that  dark  rooms  and  dusty  trades,  the 
use  of  phosphorus,  mercury,  lead,  and  other  similar  sub- 
stances in  manufacture,  and  the  failure  to  provide  for  the 
health  of  the  young,  are  potent  causes  of  much  morbidity  and 
'  Popular  Science  Monthly  for  April,  1913,  p.  382. 


28  EDUCATIONAL  HYGIENE 

mortality.  It  has  been  estimated  that  in  this  country  each 
year  about  500,000  industrial  accidents  occur,  at  least  one- 
half  of  which  might  be  prevented;  that  we  have  in  our  midst 
every  year  13,500,000  cases  of  industrial  sickness,  involving 
a  loss  to  society  of  about  $800,000,000,  and  that  of  this  loss 
we  can  save  at  least  one-quarter.^  Here  is  a  burning  problem, 
but  the  public-health  movement  cannot  as  yet  boast  of 
great  accomplishments  in  these  directions.  Studies  are  be- 
ing made  and  remedial  legislation  devised,  but  the  machinery 
for  its  enforcement  is  inadequate,  and,  what  is  almost  as  im- 
portant, no  adequate  educational  machinery  is  at  work  to  in- 
struct and  train  the  large  masses  of  our  people  in  personal 
hygiene,  sound  health  habits  and  ideals  of  life,  and  the  pre- 
vention of  disease. 

Typhoid  Fever. — The  prevalence  of  typhoid  fever  is  a 
good  index  of  social  and  sanitary  conditions.  It  is  a  disease 
whose  etiology  and  method  of  transmission  are  well  known, 
and  is  therefore  well  controllable.  It  is  a  disgrace  to  our 
civilization  that,  in  the  registration  area  of  the  United  States 
in  191 1,  there  should  have  been  from  this  one  disease  12,451 
deaths.  These  deaths  from  typhoid  mean  at  least  124,510 
cases  of  prolonged  sickness  (ten  times  the  number  of  deaths) 
whose  origin  was  clearly  due  to  the  drinking  and  eating  of 
food  which  was  contaminated  by  the  excreta  of  typhoid  pa- 
tients. In  the  majority  of  our  cities  drinking-water  is  obtained 
from  rivers  and  lakes  into  which  typhoid-infected  sewage  is 
or  may  be  discharged.  It  is  gratifying  to  learn  that  many  of 
the  cities  are  taking  steps  to  safeguard  the  quality  of  the 
drinking-water  by  installing  filter  plants.  But  still  a  com- 
parison of  the  death-rates  from  typhoid  in  European  and 
American  cities  is  a  severe  indictment  of  our  indifference  in 
matters  of  health  and  life  protection.  The  following  is  a 
comparative  table  of  the  death-rates  from  typhoid  fever  in 
certain  large  cities  of  the  world  for  the  year  1910: 

'John  B.  Andrews,  "Industrial  Diseases  and  Physicians,"  Journal  of  the 
American  Medical  Association,  April  15,  1911,  vol.  56,  p.  1132. 


THE   PUBLIC-HEALTH   MOVEMENT  29 

DEATHS  FROM  TYPHOID  FEVER  PER  100,000  POPULATION 


City 

Death-rate 

City 

Death-rate 

Hamburg 

Berlin 

2.5 
3.6 
4.0 
4.1 
6.7 
4.2 

New  York 

Boston 

II. 6 
II. 6 
13-7 
17.4 
23.2 
iS-5 

Chicago 

Philadelphia 

Washington,  D.  C. 
Average 

Paris 

Average 

Not  all  of  the  typhoid  fever,  of  course,  comes  from  pol- 
luted water  supplies.  A  great  deal  of  it  comes  from  polluted 
milk  and  its  products,  from  oysters,  vegetables,  shell-fish, 
etc. ;  and  a  good  deal  of  it  also  comes  from  the  polluted  fingers 
of  those  who  are  either  carriers  (well,  yet  carrying  the  germs) 
or  who  attend  patients  and  do  not  take  care  to  clean  and  dis- 
infect themselves  properly.     It  has  been  estimated  that  at 

TYPHOID  FEVER  DEATHS  IN  INDIANA 
By  Ages 


IBOr 


140 

120 
100- 

80- 
60- 
40- 
20- 


m  _ 

1    1 
i    1 

i    1    ^ 

S;       ^       ^ 

^ 

1  ^  ifi 

Ui-iu^^ 

MafMk\ 

E   .: 

III     IllItQ 

un 

160 
140 
120 
100 
80 
60 
40 


20 


15  20  25  30  35  40  45  50  55  60  65  70  75  80   90 
19/24  29  34  39  44  49  54  59  64  69  74  79  90 

[   ^^  .  ^-Average  for  Last  Ten  Years 

Typhoid  fever,  like  tuberculosis,  finds  more  victims  in  the  years  immedi- 
ately following  the  school  period,  possibly  somewhat  earlier.  Tj^jhoid  is  85 
per  cent  preventable,  according  to  Fisher  and  others.  Most  deaths  occur  from 
August  to  December, 


30  EDUCATIONAL  HYGIENE 

least  lo  per  cent  of  typhoid  in  New  York  City  is  of  this  so- 
called  secondary  origin.  Here,  again,  the  need  of  education 
in  hygiene  is  obviously  a  potent  force  in  disease  prevention.^ 

A  great  deal  also  remains  to  be  done  in  the  country  dis- 
tricts, where  the  prevalence  of  typhoid  is  very  great.  Much  of 
our  city  typhoid  is  of  direct  rural  origin,  as  evidenced  by  the 
characteristic  increase  of  the  wave  of  prevalence  of  the  dis- 
ease in  the  early  autumn  when  people  return  from  their  sum- 
mer vacations  in  the  country. 

Pure  Food. — The  fact  that  many  cases  of  typhoid  and 
other  diseases  are  derived  from  milk  and  other  perishable 
foods  leads  to  the  consideration  of  the  food  problem,  which  of 
late  has  received  much  popular  attention.  Unfortunately, 
however,  perhaps  too  much  emphasis  is  being  laid  on  the  use 
of  preservatives  in  canned  foods  and  not  enough  stress  on  the 
control  of  perishable  foods,  which  are  the  most  important 
carriers  and  disseminators  of  disease.  Very  few  instances  of 
death  or  serious  illness  can  be  clearly  traced  to  food  preserv- 
atives or  to  such  so-much-discussed  substitutes  as  oleomar- 
garine, glucose,  etc.,  but  hundreds  of  thousands  of  deaths 
are  undoubtedly  due  directly  to  contaminated  milk,  water, 
meat,  oysters,  and  other  perishable  foods.  The  public-health 
movement  has  not  as  yet  definitely  stated  the  food  issue  or 
clearly  indicated  its  proper  mode  of  solution. 

The  food  problem  has,  of  course,  as  great  an  economic  as 
a  health  aspect.  The  economic  element  of  the  problem  is 
very  important  but  it  should  not  be  confused  with  the  health 
issue.  To  add  apple  jam  to  raspberry  jelly,  or  potato  flour 
to  sausage,  may  be  good  business  and  bad  ethics,  but  it  is 
largely  a  matter  of  indifference  from  the  point  of  view  of 
pubhc  health.  Whether  a  certain  appetizing  and  high-priced 
preparation  or  expensive  cut  of  meat  has  little  nutritive  value 
is  also  almost  entirely  an  economic  problem.  That  March 
or  April  eggs  are  kept  in  cold  storage  till  November  and  then 

'See  Winslow's  article  on  "Man  and  the  Microbe"  in  the  Popular  Science 
Monthly  for  July,  1914. 


THE   PUBLIC-HEALTH   MOVEMENT  3 1 

bring  better  prices  than  they  would  in  April  is  also  a  matter 
of  practically  no  concern  to  the  public-health  administrator. 
His  concern  is  to  see  that  the  eggs  or  meat  are  fresh  and  sound 
when  put  into  cold  storage,  and  also  that  when  once  taken 
out  of  storage  and  allowed  to  thaw  they  are  not  put  there 
again. 

Our  present  stage  of  industrial  development  has  created 
a  need  for  cold  storage  and  the  production  of  foods  on  a  factory 
scale.  It  would  be  useless  to  combat  this  tendency.  It  is 
necessary,  however,  to  control  this  modern  wholesale  produc- 
tion of  foods  in  a  rational  and  scientific  manner  and  see  that 
the  conditions  under  which  they  are  being  produced  are  sani- 
tary, that  the  workmen  employed  are  healthy  and  cleanl}^,  and 
that  the  raw  products  used  are  free  from  contamination  and 
disease.  The  sporadic  and  irrational  outbursts  of  revolt  with 
little  scientific  basis  have  resulted  in  a  hodge-podge  of  legisla- 
tion which  is  a  hardship  and  a  nuisance  to  the  honest  producer, 
and  is,  at  best,  of  little  benefit  to  the  consumer.  At  the  pres- 
ent time  there  is  practically  no  uniformity  of  standards  and 
no  uniformity  of  requirements.  What  may  be  legal  in  one 
State  may  be  illegal  in  another,  and  vice  versa.  As  Mr.  Dunn, 
the  author  of  a  standard  digest  of  food  laws,  says,  "pure  food 
legislation  is  a  mass  of  inconsistencies.  The  federal  authorities 
and  the  State  of  Wisconsin  say  that  flour  bleached  with  nitro- 
gen of  peroxide  is  injurious.  But  Missouri,  Oklahoma,  Indi- 
ana, South  Carolina,  and  Wyoming  permit  its  sale  if  the 
bleaching  process  is  indicated  in  the  label.  Illinois  has  made 
it  illegal  to  bleach  grain  with  sulphur  dioxide,  yet  the  sale  of 
this  grain,  when  properly  labelled,  is  permitted  by  the  federal 
law."i 

What  the  pubUc-health  movement  has  not  as  yet  accom- 
phshed  in  this  direction  is  scientific  standardization  and  the 
securing  of  uniformity  of  legislation.  If,  after  reliable  scientific 
data  on  a  certain  problem  had  been  obtained,  the  represent- 
atives of  the  several  States  would  come  together  and  agree 
*  New  York  Times  for  January  25,  19 14. 


32  EDUCATIONAL  HYGIENE 

on  a  certain  method  of  procedure  and  secure  approximate  or 
standard  legislation  for  its  enforcement,  the  spectacle  of  two 
adjoining  States  having  different  laws  on  the  subject,  with 
all  its  injurious  effects,  would  be  made  impossible. 

There  are  many  matters  which  could  even  at  present  be 
dealt  with  adequately  if  a  common  standard  were  adopted. 
Why,  for  example,  should  the  unscrupulous  milk-dealer  whose 
milk  has  been  barred  out  of  one  city,  because  it  has  been 
found  to  be  infected  with  typhoid-fever  germs,  be  allowed  to 
sell  it  in  another  city  where  the  regulations  are  less  exacting 
and  thereby  cause  an  epidemic  of  the  disease?  Why  should 
the  owner  of  tuberculous  cattle  be  allowed  to  sell  his  meat 
within  a  State  when  the  federal  authorities  would  condemn 
it  for  interstate  commerce?  These  are  some  of  the  many 
problems  concerning  the  food  question  which  the  pubhc- 
health  movement  must  solve  in  the  interest  of  efficient  ad- 
ministration and  the  proper  protection  of  society,  and  which 
can  only  be  accomplished  by  proper  co-operation  of  the  va- 
rious pubHc  and  private  health  agencies.^ 

Infant  Mortality. — As  some  one  has  said,  the  business  of 
being  a  baby  is  an  extremely  hazardous  one.  As  late  as  the 
year  191 2,  with  all  our  efforts  to  reduce  infant  mortality,  out 
of  the  total  of  838,251  deaths  in  the  registration  area  of  the 
United  States,  147,455  deaths,  or  17.6  per  cent,  occurred  among 
children  under  one  year  of  age,  and  204,639  deaths,  or  24.4 
per  cent,  among  children  under  five  years  of  age.  Almost 
one-fourth  of  all  the  deaths  occur  before  the  child  reaches  the 
age  of  five,  three-fourths  of  which  occur  in  the  first  year  of  Hfe. 
Fortunately  there  has  been  a  marked  reduction  in  the  infant 
death-rate  in  recent  years.  The  following  table  gives  a  com- 
parison of  the  death-rates  under  one  year  of  age  in  the  same 
States  and  cities  for  the  years  of  1900  and  191 1. 

In  some  States  and  cities  the  reduction  in  infant  mortality 
was  more  than  30  per  cent  during  this  twelve-year  period. 
In  Rhode  Island  it  has  decreased  from  197.9  to  138.6  per 
» See  also  the  chapter  on  School  Feeding. 


THE    PUBLIC-HEALTH   MOVEMENT  33 

DEATH-RATE  PER  I,000  POPULATION  UNDER  ONE  YEAR  OF  AGE 


Area 


STATES   OF  THE  REGISTRA 
HON    AREA    IN    IQOO... 

Connecticut 

Maine 

Massachusetts 

Michigan 

New  Hampshire 

New  Jersey 

New  York 

Rhode  Island 

Vermont 

CITIES  WITH  100,000  POPU 
LATION   OR   over: 

San  Francisco 

Denver 

Washington,  D.  C , 

Chicago , 

Boston 

St.  Louis 

New  York  City 

Philadelphia 


129. 5 
130.9 
no. 9 
143 -3 
III  .4 
150.3 
131-5 
128.8 
138.6 
102.0 


104.8 
131-9 
170.0 
123-3 
160.9 
123.8 
130.6 
141.9 


159-3 
156.8 
144. 1 
177.8 
121. 3 
172.0 
167.4 
159.8 
197.9 
122. 1 


152.2 
162.3 

274-5 
146.6 
194. 1 
162.4 

189.4 
201 .9 


Per  cent 
of  decrease 


19 
17 
23 
19 
8 

13 
21 

19 
30 
16 


31 
19 
38 
16 
17 
24 
31 
30 


1,000  children  under  one  year  of  age.  In  the  city  of  Wash- 
ington, D.  C,  it  has  been  reduced  from  274.5  in  1900  to  170.0 
in  191 1,  and  so  on. 

The  deaths  of  infants  have  both  hereditary  and  environ- 
mental causes,  the  latter  being  much  more  important;  diar- 
rheal and  respiratory  diseases  which  result  from  bad  feeding, 
bad  air,  filth,  ignorance,  carelessness,  and  poverty  being  the 
chief  causes  of  infant  mortahty.  The  main  bulk  of  infant 
deaths,  in  the  last  analysis,  are  of  an  environmental  origin 
and  can  be  annihilated  only  by  a  change  in  environment,  in- 
cluding proper  education. 

Milk  Stations. — One  of  the  potent  factors  in  reducing 
infant  mortahty  has  been  the  milk  station.  Thorough  and 
repeated  studies  of  infant  mortahty  here  and  abroad  have 
shown  that  the  chances  of  a  breast-fed  child  are  at  least  five 
times  better  than  the  chances  of  an  artificially  fed  baby. 
Nature  did  not  intend  that  cows  should  nurse  human  babies, 
and  our  carelessness  and  ignorance  have  added  additional 


34 


EDUCATIONAL   HYGIENE 


dangers  to  this  anomaly.  If  a  large  percentage  of  our  babies 
must,  for  economic  and  other  reasons,  be  artificially  fed,  then 
steps  must  be  taken  to  secure  for  them  safe  food.  Whenever 
this  has  been  tried  and  milk  depots  established,  infant  mor- 
tality has  been  decreased. 

Education  of  mothers  at  the  milk  depots,  at  the  schools, 
or  both  in  one,  is  a  factor  in  the  situation  whose  importance 
should  not  be  underestimated.  In  his  paper  on  ''Infant 
Milk  Depots,"  read  at  the  Conference  on  Infant  Hygiene 
held  in  conjunction  with  the  Philadelphia  Baby  Saving  Show, 
191 2,  Doctor  Rowland  G.  Freeman  estimated  on  the  basis  of 
much  experience  that  milk  stations  plus  education  of  mothers 
can  produce  a  60-per-cent  reduction  in  infant  mortality,  of 
which  15  per  cent  should  be  credited  to  instruction,  leaving  a 
net  gain  of  45  per  cent  due  to  pure  milk.^  These  figures  are 
almost  as  arbitrary  as  they  are  optimistic.  We  have  no 
means  to  measure  the  importance  of  instruction  in  hygiene, 
and  nowhere  in  this  country  have  we  secured  a  60-per-cent 
reduction  in  infant  mortality.  One  reason  for  our  failure  to 
secure  it  lies  in  the  fact  that  we  have  not  taken  steps  to  de- 
crease infant  mortality  from  the  so-called  congenital  dis- 
eases from  which  deaths  occur  and  which  constitute  37  per 
cent  of  the  total  infant  mortality  in  the  registration  area  dur- 
ing the  first  month  of  life.  The  greatest  reduction  in  mor- 
tality has  taken  place  in  the  case  of  diarrheal  diseases,  then 
in  respiratory,  and  very  little  in  congenital  diseases,  includ- 
ing in  this  class  of  diseases  congenital  debility,  malformations, 
premature  births,  injuries  at  birth,  etc. 

Prenatal  Work. — To  bring  about  a  further  reduction  in 
infant  mortality  the  public-health  movement  must  devise 
means  for  reducing  the  number  of  deaths  from  congenital 
diseases.  This  can  in  a  large  measure  be  accomplished  through 
centres  for  prenatal  care  of  the  mothers.  The  report  of  the 
Russell  Sage  Foundation  on  "Prenatal  Work  in  Certain 
American  Cities,"  presented  at  the  Fifteenth  International 
*  Proceedings  of  the  Conference  on  Infant  Hygiene,  1913,  p.  201. 


THE    PUBLIC-HEALTH   MOVEMENT 


35 


DIARRHEAL  DISEASES   IN  INDIANA 
By  Ages 


1300 


1100 


1000 


900 


800 


700 


600 


500 


400 


300 


200 


100 


j 

! 

1 

■J 

1 

t  i 

n 

!l 

i  1 

1  1 
1  1 

1  -^ 

li 

■^ 

■^ 

■  ITI 

■  F^ 

■E^ 

wm 

■^ 

■^ 

IF1 

■n 

iFI 

if 

r 

1 

in 

1 

1 

■i 

0  1   2  3  4   5  10  15  20  25  30  35  40  45  50  55  60  65  70  75  80  90 

1  2  3  4  ^,5  9  14  19^24  29  34  39  44  49  54  59  64  69  74  79  90 


1912 


Average  for  Last  Ten  Years 


These  diseases  are  the  chief  infant  destroyers  and  are  largely  preventable. 
Can  we  not  train  for  this  phase  of  parenthood  in  the  schools? 


36  EDUCATIONAL  HYGIENE 

Congress  on  Hygiene  and  Demography  in  191 2,  shows  that 
the  work  is  still  in  the  initial  stages,  there  being  but  a  few 
scattered  efforts  here  and  there.^  Reahzing  the  lack  of  care 
of  expectant  mothers  and  the  resultant  appallingly  great 
death-rate  from  congenital  diseases,  Doctor  Newmayer  ad- 
vocates municipal  supervision  of  maternity.- 

"  There  should  be  legislation  which  would  require  all 
hospitals  and  dispensaries  conducting  an  outdoor  service  to 
report  to  the  health  officer  the  names  and  addresses  of  all 
expectant  women  presenting  themselves  at  these  institutions 
for  confinement.  The  city  authorities  should  have  trained 
nurses  detailed  to  visit  these  prospective  mothers  during  the 
last  month  or  two  of  pregnancy,  observing  any  signs  of  ab- 
normality, instructing  the  mother  in  personal  hygiene,  care 
of  the  breasts,  and  preparing  the  mother  for  the  time  of  labor. 
The  nurse  should  continue  her  visits  after  the  birth  of  the 
child,  in  order  to  instruct  in  the  care  and  feeding  of  the  baby. 
Such  precautions  would  reduce  materially  the  early  deaths 
by  avoiding  many  accidents  and  would  also  assure  more 
breast-fed  babies.  In  such  work  the  visiting  municipal  nurse 
would  be  a  logical  solution  of  the  midwife  problem.  Foreign 
mothers,  realizing  the  value  of  the  kind  of  care  and  attention 
given  to  them,  would  naturally  wean  themselves  away  from 
the  services  of  careless  and  uncleanly  mid  wives,  and  those 
midwives  remaining  in  practise  would  be  compelled  to  be- 
come more  skilled  and  painstaking  in  their  work." 

This  is  but  a  logical  extension  of  the  work  which  is  now 
being  carried  on  by  the  larger  cities  of  the  country  in  the 
interests  of  the  conservation  of  the  child  and  which  is  bound 
to  expand.  Public  schools  through  home-visiting  nurses 
and  consultation  hours  at  schools  for  mothers  and  expect- 
ant mothers  are  already  doing  much  valuable  service.  The 
twentieth  century  has  been  dedicated  to  the  welfare  of  the 
child,  and  the  promise  is  great. 

'Ellen  C.  Babbitt,  Proceedings  of  the  Congress,  vol.  3,  pt.  i,  p.  304. 
^S.  W.  Newmayer,  Proceedings  of  the  Congress,  vol.  3,  pt.  i,  p.  402. 


THE  PUBLIC-HEALTH  MOVEMENT  37 

School  Medical  Supervision. — One  of  the  first  activities 
in  the  direction  of  child  conservation  was  medical  supervision, 
or  ''inspection,"  of  school-children.  When  first  organized,  it 
met  with  the  objection  that  it  was  a  measure  to  pauperize 
the  people,  forgetting  that  public  schools  were  inaugurated 
as  pauper  schools  and  that  now  they  are  compulsory.  The 
experience  of  the  last  fifteen  years  goes  to  show  that  the  com- 
munities that  have  introduced  medical  school  inspection  have 
been  entirely  justified  in  their  expenditures  by  assuring  to 
their  future  citizens  a  good  start  in  life,  since  the  majority  of 
the  children's  ailments  and  incipient  diseases  are  being  dis- 
covered at  a  period  when  they  can  easily  be  remedied.  Many 
of  the  parents  of  the  children  who  are  found  suffering  from 
one  or  another  physical  defect  take  steps  to  have  these  de- 
fects corrected  or  cured.  Many  of  them,  however,  are  too 
indifferent,  too  poor,  or  too  ignorant  to  take  the  proper  action 
and  are,  unfortunately,  more  ready  to  evade  health  advice 
than  to  follow  it.  And  here  is  the  point  where  medical  school 
inspection  frequently  fails.  As  at  present  constituted,  it  does 
not  commonly  go  much  beyond  the  pointing  out  of  defects, 
leaving  it  to  those  most  interested  in  the  welfare  of  the  chil- 
dren to  have  them  attended  to  and  treated.  A  recent  study 
of  the  efficiency  of  the  system  based  on  the  records  of  four 
schools  in  the  city  of  New  York  showed  that  when  the  school 
authorities  co-operate  with  health  officers  a  very  high  per- 
centage of  treatments  is  obtainable,  and  where  there  is  no 
such  co-operation  the  percentage  of  treatments  does  not  in 
any  class  of  ailments  exceed  70  per  cent.  Then,  of  the  cases 
treated,  at  least  25  per  cent  resulted  in  "no  cure"  or  ''no 
improvement."  ^ 

Whooping-Cough. — Great  strides  have  been  made  in  child 
conservation,  yet  in  this  field  a  great  deal  remains  to  be  done. 
We  have  not  as  yet  turned  at  all  toward  prevention  of  a  very 
serious  and  fatal  disease  which  kills  many  thousands  of  chil- 

•  E.  H.  Lewinski-Corwin,  "The  Practical  Necessity  of  School  Clinics,"  a  paper 
read  before  the  Fourth  International  Congress  of  School  Hygiene,  Buffalo, 
N.  Y.,  1913,  and  later  printed  in  the  Popular  Science  Monthly  for  May,  1914. 


MEASLES   DEATHS  IN  INDIANA 
By  Ages 


40 

^ 

1 

25 

1 

1 

1 

^0 

^ 

i 

■^ 

y 

1 

10 

5 

1 

\ 

it 

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1 

1 

1 

1 

1 

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in 

F 

i: 

iQ 

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40 


35 


30 


25 


20 


10 


-1912 


5  10  15  20  25  30  35  40  45  50  5.5  60  65  70  75  80  90 
9  14  JJ/ 24  29  34  39  44  49  54  59  64  69  74  79  90 

[  ]-Avefage  for  Last  Ten  Yeacs 


Showing  the  ages  when  measles  are  most  fatal  and  common  and  the  impor- 
tance of  home  care  in  the  pre-school  years. 


700 
600 
500 
400 
300 
200 
lOOl 


TUBERCULOSIS   DEATHS  IN  INDIANA 
By  Ages 


loLlDl 


700 
600 
500 
400 
300 
200 
100 


2  3  4  5  10  15  20  2-5  80  35  40  45  50  55  60  65  70  75  80  90 

3  4  v5  9  14  19/24  2.9  34  39  44  49  54  59  64  69  74  79 
1912 


Average  for  Last  Ten  Years 


While  tuberculosis  (all  forms)  is  not  relatively  very  frequent  in  the  school 
ages  according  to  this  chart,  yet  deaths  from  tuberculosis  stand  near  the  first 
in  causes  of  death  among  school-children,  and  the  school  must  help  eliminate 
the  deaths  of  former  pupils. 

38 


DIPHTHERIA   DEATHS  IN   INDIANA 
By  Ages 


180/ 


160 
140 


120 


100 


80 


eo 


40 


20 


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160 
140 


120 


100 


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40 


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4  5      10     15     20    25    30    35    40    45     50    55    60    65     70 

5  9      14     19/  2^    29     94    39     44    49     54     59    64    69     79 
I  j-Averape  lor  Last  Ten  Yeais 

Diphtheria  finds  its  victims  in  the  pre-high-school  years.     Most  deaths 
occur  from  September  to  January. 

SCARLET  FEVER  DEATHS   IN  INDI.\NA 
By  Ages 


0 

1 

1  2 

2  3 

3 
4 

4 
^5 

5         10 
9         14 

15        20 
19y    24 

25 
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30       35       45       55 
34       44        54        90 

>r" 

1 

^^-1912 

M 

-Average  for  Last 
Ten  Years 

Scarlet  fever  is  another  disease  of  the  pre-high-school  period,  quite  largely. 
Deaths  occur  throughout  the  school  year,  but  the  number  is  a  third  as  great 
throughout  the  siunmer. 

39 


40  EDUCATIONAL  HYGIENE 

dren  per  annum  and  the  death-rate  of  which  is  as  high  as  that 
of  scarlet  fever  and,  in  some  parts  of  the  country,  much  higher. 
I  refer  to  whooping-cough.  The  recent  reports  of  Doctor 
Rucker,  of  the  United  States  PubHc  Health  Service,  and  of 
Doctor  John  Lovett  Morse,  of  Harvard,  deserve  serious  con- 
sideration. It  is  true,  as  Doctor  Rucker  says,  that,  "if  bubonic 
plague  were  to  kill  as  many  children  in  the  United  States  in 
one  year  as  whooping-cough  does,  the  whole  world  would 
quarantine  against  our  country."  And  yet  the  disease  is 
popularly  regarded  as  of  a  trifling  nature,  and  scarcely  any 
measures  are  being  taken  to  limit  its  spread  and  diminish 
the  death-rate  from  it.  Only  twenty-nine  of  the  forty- three 
States  that  answered  an  inquiry  made  by  Doctor  Morse  re- 
quire reporting  of  the  disease  to  the  health  departments,  and 
in  those  where  notification  is  required  very  little  attention  is 
paid  to  it  by  physicians.^ 

Disinfection  after  this  disease  is  required  by  law  in  only 
four  States  of  the  Union  and  "recommended  but  rarely  en- 
forced" in  but  one.  In  some  States  there  is  no  law  forbid- 
ding the  attendance  of  children  with  whooping-cough  at 
schools;  others  forbid  but  have  no  regulations  as  to  how 
long  they  should  be  kept  out  of  schools.  The  same  inade- 
quacy and  lack  of  definiteness  relates  to  regulations  pro- 
hibiting the  school  attendance  of  other  children  in  the  fam- 
ily. And  then,  "there  is  almost  no  provision  for  the  hos- 
pital treatment  of  whooping-cough  in  this  country."  There 
are  only  a  few  hospitals  in  the  country  that  have  provisions 
made  for  these  cases.  In  this  connection  it  may  be  of  in- 
terest to  quote  the  medical  officer  of  the  Local  Government 
Board  of  London,  who,  in  speaking  of  whooping-cough  and 
measles,  says,  "the  most  hopeful  line  of  action  in  respect  to 
both  of  these  diseases  appears  to  lie  in  the  hospital  treatment 
of  patients  for  whom  adequate  domestic  nursing  cannot  be 
secured. "2 

'"Whooping-cough,"  Journal  of  the  American  Medical  Association,  May 
31,  1913,  pp.  1677-1680. 

*  Forty-first  Annual  Report  of  the  Local  Government  Board,  1911-12,  p.  x.xv. 


THE   PUBLIC-HEALTH  MOVEMENT  4I 

There  is  also  no  provision  for  the  treatment  of  these  cases 
in  the  out-patient  departments  of  the  hospitals.  In  the  ma- 
jority of  the  climes  the  children  are  not  allowed  to  return  for 
treatment  for  fear  of  infecting  other  children  in  the  waiting- 
rooms.  In  some  clinics  they  are  allowed  to  return  and  are 
''treated  on  the  sidewalk,"  at  the  beginning  or  end  of  the 
clinics.  In  a  few  clinics  only  are  these  cases  treated  at  an 
entirely  different  hour  from  the  other  patients.  We  have 
here  an  important  and  serious  task  before  us. 

Contagious  Diseases. — The  control  of  contagious  dis- 
eases and  the  matter  of  efficient  home  and  school  quarantine 
occupy  a  central  position  in  pubhc-health  administration. 
Contagious  diseases  come  and  go  in  waves  or  cycles  recurring 
more  or  less  regularly  despite  the  comparatively  definite 
knowledge  we  possess  of  the  causes  and  methods  of  trans- 
mission of  some  of  them.  To  what  extent  isolation  or  segre- 
gation of  the  sick  is  an  element  in  the  control  of  such  diseases 
we  have  no  direct  statistical  data  to  determine.  We  know 
that  rise  and  fall  in  the  waves  is  dependent  on  the  ratio  of 
the  number  of  infected  persons  to  the  available  infectable 
population.  We  can  observe  this  particularly  well  with  ref- 
erence to  some  diseases,  like  smallpox,  for  instance.  When 
the  occurrence  of  cases  of  smallpox  becomes  known  in  a  com- 
munity there  is  a  universal  rush  for  vaccination  and  the  epi- 
demic soon  dies  out.  After  a  lapse  of  a  few  years,  during 
which  no  thought  has  been  given  to  the  disease  and  during 
which  immunity  in  many  instances  has  ceased  and  the  avail- 
able infectable  population  has  increased,  the  wave  begins  to 
rise.  This  is  probably  true  of  every  contagious  disease.  The 
difference  in  the  incidence  of  the  same  disease  therefore  is  an 
indication  of  certain  conditions  with  reference  to  immunity. 
Segregation  and  isolation  of  cases  is  undoubtedly  the  most  im- 
.  portant  movement  in  the  situation,  the  extent  of  which  we  are 
thus  far  unable  statistically  to  determine.  The  comparison  of 
the  two  curves  of  incidence  of  measles  in  Philadelphia  and 
New  York  shown  on  a  chart  published  by  the  Prudential 


42  EDUCATIONAL  HYGIENE 

Life  Insurance  Company  suggests  that  the  tenement-house 
congestion  of  a  large  portion  of  the  population  of  the  city 
of  New  York  may  be  the  reason  for  the  greater  incidence 
of  measles  in  New  York  than  in  Philadelphia. 

Vital  Statistics. — As  can  perhaps  be  seen  from  this  hasty 
review,  our  community  health  programme  has  not  been  worked 
out  in  detail;  plans  for  a  rational  development  have  not  been 
laid  out  carefully  and  with  precision;  the  various  elements 
entering  the  field  have  not  been  scrutinized,  balanced,  and 
weighed  against  each  other.  There  is  a  great  deal  of  dilettan- 
tism and  inefficiency  about  our  public-health  administration. 
One  reason  for  this  state  of  affairs  is  lack  of  the  indispensable 
bases  of  correct  judgment,  adequate  vital  statistics.  When 
only  60  per  cent  of  the  population  of  this  country  is  included 
in  the  registration  area,  when  our  returns  as  they  exist  are 
incomplete  and  unreliable,  and  then,  when  collected,  no  ade- 
quate analysis  of  them  is  made  in  most  of  the  communities, 
bow  can  we  expect  to  be  able  to  direct  the  course  of  public- 
health  administration  with  precision?  In  very  many  in- 
stances, in  view  of  the  lack  of  adequate  reliable  data,  we  have 
to  depend  on  theories  and  suppositions  which  may  or  may 
not  be  correct,  having  no  foundation  in  definite  ascertain- 
able facts. 

Take  as  an  average  example  the  antituberculosis  cam- 
paign. In  his  masterful  pamphlet  on  ''The  Fight  Against 
Tuberculosis  and  the  Death  Rate  from  Phthisis,"  ^  Karl 
Pearson  takes  exception  to  certain  assertions  and  points  out 
with  great  acumen  the  flimsy  and  scanty  grounds  from  which 
we  draw  our  deductions  with  reference  to  the  various  factors 
in  the  fight  against  tuberculosis.  The  following  is  an  example 
of  perfectly  sound  reasoning  for  which  no  statistical  evidence 
is  at  present  available.  The  Department  of  Health  of  the 
City  of  New  York  has  recently  published  a  study  made  by 
the  Council  of  Jewish  Women  on  "The  Subsequent  History 
of  Patients  Discharged  from  Tuberculosis  Sanatoria. "^  San- 
'  London,  1911.  '"Monograph  Series,"  No,  8,  October,  1913,  p.  18, 


THE   PUBLIC-HEALTH   MO\EMENT  43 

atoria  statistics  are  extremely  poor,  and  the  report,  after  an 
analysis  of  the  medical  data  of  three  tuberculosis  sanatoria, 
says:  "A  hasty  study  of  the  foregoing  three  tables  might 
lead  to  the  conclusion  that  sanatorium  treatment  of  the  tu- 
berculous was  largely  futile.  As  a  matter  of  fact,  however, 
this  would  be  a  great  mistake.  The  work  done  by  the  san- 
atoria is  not  only  highly  beneficial  to  the  patients,  but  is  abso- 
lutely indispensable  in  the  campaign  against  tuberculosis." 

This  view  is  probably  entirely  right  but  it  does  not  follow 
from  the  statistics  analyzed.  If  public  health  is  ever  to  be 
raised  to  the  dignity  of  a  science  with  sufficient  authority  to 
bestow  on  its  adepts  the  degree  of  D.P.H.  (Doctor  of  Public 
Health),  it  must  endeavor  to  procure  indisputable  proof  for 
its  assertions  and  behefs.  We  are  not  yet  sufficiently  aroused 
to  the  crying  need  of  what  Professor  Pearson  calls  "an  effi- 
cient medico-statistical  logic." 

Municipal  Expenditures  for  Health.— In  spite  of  the  oft- 
repeated  saying  that  an  ounce  of  prevention  is  worth  more 
than  a  pound  of  cure,  and  in  spite  of  the  wide-spread  recog- 
nition of  the  fact  that  public  health  is  purchasable,  our  com- 
munity appropriations  for  pubHc  health  do  not  indicate  that 
we  apply  these  principles  on  a  large  scale  in  practise. 

Out  of  a  total  $449,219,789  spent  by  184  cities  of  the 
United  States  in  1910,  $9,059,173,  or  2  per  cent  only,  went 
for  health  conservation  proper.^  The  average  per-capita 
cost  of  city  administration  in  the  United  States  (exclud- 
ing payments  for  expenses  of  public-service  enterprises)  was 
$16.45  ill  1910.  Of  this  amount  only  33  cents  went  for  health 
conservation,  about  one-fiftieth.  The  smaller  the  cities,  the 
smaller  is  the  average  per-capita  cost  for  public  health.  In 
the  cities  of  Group  I,  i.  e.,  cities  having  a  population  of 
300,000  or  over,  the  average  for  health  conservation  is  41 
cents;  in  the  cities  of  Group  II  (from  100,000  to  300,000 
population)  it  falls  to  27  cents.  Cities  of  Group  III  (popu- 
lation 50,000  to  100,000)  spend  21  cents  per  capita,  and  those 
1"  Statistics  of  Cities,  1910,"  p.  135. 


44  EDUCATIONAL  HYGIENE 

of  Group  IV  (population  30,000  to  40,000)  can  boast  of  an 
expenditure  for  health  of  but  19  cents. ^ 

The  health  conditions  in  the  smaller  towns  and  country- 
districts  are  particularly  unsatisfactory. 

Conclusion. — The  foregoing  cursory  review  presents  the 
main  problems  of  the  pubhc-health  movement,  which  is 
gaining  a  tremendous  impetus  in  this  country.  It  can  be 
seen  that  a  great  deal  remains  to  be  done,  but  the  most  im- 
portant problems  facing  the  movement  are  education,  con- 
centration, and  co-operation,  all  essential  to  the  conservation 
of  effort  and  to  the  checking  of  unnecessary  waste  of  energy 
and  money.  After  a  statement  of  the  hereditary  basis  of 
health  work  in  the  next  chapter,  the  later  chapters  will  show 
how  to  meet  many  of  these  problems  through  the  widening 
influence  of  the  public  school,  democracy's  chief  agency  for 
permanent  health  improvement. 

1  Same  report,  p.  64. 


CHAPTER  III 
HEALTH   AND    HEREDITY 

The  Infinite  Varieties  of  Traits  in  American  Children. — 

Modern  views  of  heredity  in  man  start  with  the  principle  of 
the  essential  diversity  of  human  beings  in  any  mixed  popu- 
lation such  as  the  United  States  aflfords.  Though  there  are 
countries,  using  the  word  in  its  broadest  sense,  in  the  Old 
World  whose  population  is  blue-eyed,  others  where  all  the 
people  have  curly  or  kinky  hair,  others  where  the  nose  is 
aquiline,  others  where  practically  all  are  tall,  and  so  on,  in 
this  country  all  these  physical  traits  are  for  the  most  part 
much  mixed  together.  It  is  because  the  population  of  this 
country  is  so  greatly  hybridized  that  the  people  are  so  differ- 
ent. It  follows,  first  of  all,  that  there  are  few  rules  that  hold 
for  all  people.  A  neglect  of  this  fact  is  in  part  responsible  for 
the  failure  of  works  on  pedagogy,  or  hygiene,  or  medicine, 
to  command  universal  respect.  We  learn  that  the  child's 
mind  works  so  and  so,  in  face  of  the  fact  that  "the  child"  is 
an  abstraction;  we  are  taught  how  to  care  for  the  teeth, 
despite  the  fact  that  "the  teeth"  are  a  mythical  thing;  and 
we  learn  of  the  prognostication  of  "typhoid  fever"  as  though 
it  were  a  definite  phenomenon  that  needed  only  to  be  seen 
to  be  recognized,  instead  of  the  different  kinds  of  behavior 
of  various  living  human  bodies  to  the  parasite  that  is  called 
bacillus  typhosus. 

As  I  have  said,  the  child-mind  is  a  pure  abstraction.  Actu- 
ally we  have  the  minds  of  various  children  which  are,  in  the 
extreme,  so  unlike  that  they  have  few  features  in  common. 
Nor  does  it  help  much  to  divide  them  into  the  feeble-minded 
and  the  normal,  or  the  wayward  and  the  normal,  for  "the 

45 


46  EDUCATIONAL  HYGIENE 

normal"  is  itself  a  scholastic  and  pedantic  figure  of  speech 
and  does  not,  strictly  speaking,  correspond  with  anything 
found  in  nature.  The  teacher  who  relies  solely  upon  what 
he  has  learned  from  the  books  about  the  child's  mind  will 
be  far  less  successful  than  the  teacher  of  common  sense 
who  has  had  a  wide  range  of  experience  with  children's 
minds} 

Similarly,  the  instructions  as  to  the  care  of  "the  teeth" 
are  of  comparatively  Httle  use  to  certain  races,  notably  West 
African  negroes,  whose  teeth  are  highly  resistant  to  caries, 
and  their  faithful  application  will  probably  do  little  to  delay 
the  ravages  of  decay  in  the  teeth  of  those  who  are  non-re- 
sistant. How  often  may  one  hear  of  a  white  person  who  has 
not  lost  a  tooth  in  his  head  and  had  never  been  to  a  dentist 
and  makes  Uttle  or  no  use  of  a  tooth-brush.  On  the  other 
hand,  you  will  frequently  find  those  whose  constant  use  of 
antiseptic  tooth-washes  does  little  to  stay  the  rapid  loss  of  the 
entire  set.  It  has  even  been  contended  that  (a)  were  there 
no  tooth-brushes  there  would  be  no  more  caries  than  at  pres- 
ent, {h)  tooth-powder  is  the  real  cause  of  the  weakness  of  our 
teeth  and  water  only  should  be  used,  and  (c)  the  use  of  a 
bristle  brush  is  in  the  highest  degree  unnatural  and  is  one  of 
the  leading  causes  of  tooth  decay!  Most  other  "laws  of 
hygiene"  are  similarly  disputed.  The  fact  of  this  difference 
of  opinion  is  mute  testimony  to  the  fact  that  individual  dif- 
ferences are  not  less  important,  probably  much  more  im- 
portant, than  hygienic  conditions. 

Similarly  in  respect  to  typhoid  or  other  diseases,  what  the 
reaction  of  the  body  to  any  toxin  of  a  parasite  or  other  un- 
toward condition  working  on  the  body  is,  depends,  within 
limits,  far  more  upon  the  constitution  of  the  individual  than 
upon  the  chemical  composition  of  the  toxin,  and  the  partic- 
ular untoward  condition. 

This,  then,  is  the  first  lesson  of  modern  biology:  Health  is, 
within  limits,  more  a  matter  of  heredity  than  anything  else  and 
*  See  Thorndike's  "  Individuality." 


HEALTH  AND   HEREDITY  47 

in  so  far  as  hygiene  fails  to  take  this  fact  into  account  it  fails 
to  be  of  high  practical  value. 

Accounting  for  Individual  Differences. — Recognizing  then 
the  fundamental  importance  of  individual  differences,  it  is 
for  us  to  account  for  them.  Now,  no  person  who  is  an  agri- 
culturist will  deny  the  importance  of  good  conditions  of 
development  upon  the  matured  organism.  Proper  food, 
protection  from  extreme  environmental  conditions,  from  com- 
petition, from  parasites,  and  from  gross  accidents,  are  impor- 
tant for  any  crop  of  corn  or  calves;  so  it  is  with  man.  But 
if  under  good  culture  I  fail  where  my  neighbor  succeeds  I 
must  look  to  my  seed  or  ''strain."  EQs  potatoes  were  rot- 
resistant;  his  corn  was  from  a  "dry-farming"  strain;  his 
hogs  were  cholera-proof,  etc.  The  agriculturist  knows  that, 
given  certain  fimdamental  conditions  of  culture,  the  differ- 
ence of  yield  depends  chiefly  upon  the  hereditary  nature  of 
the  organism.  And  we  shall  find  that  these  hereditary  qual- 
ities so  reappear  in  successive  individuals  and  generations  as 
to  warrant  us  in  speaking  of  this  succession  of  similarly  en- 
dowed individuals  as  constituting  a  "biotype."  Individuals, 
then,  are  different  largely  because  they  belong  to-  different 
biotypes. 

We  have  next  to  consider  how  these  differences  that 
distinguish  one  biotype  from  ariother  become  disseminated 
throughout  the  entire  populg,tion.  This  is  the  subject  of 
heredity  in  its  narrow  sense.  And  to  understand  this  sub- 
ject we  must  clear  our  minds  of  a  lot  of  intellectual  rubbish, 
figures  of  speech,  and  mystical  ideas.  Many  persons  would 
say  that  we  inherit  traits  from  our  fathers  and  mothers. 
Strictly,  we  do  nothing  of  the  sort.  It  is  just  as  true,  in 
one  sense,  that  a  father  inherits  certain  of  his  qualities  from 
his  son.  The  fact  is  that  neither  inherits  from  the  other  any 
more  than  the  youngest  leaf  on  a  growing  shoot  inherits  its 
shape  from  the  next  older  one.  The  leaves  are  alike,  to  be 
sure,  but  they  are  alike  because  they  inherit  in  succession 
from  the  same  common  stuff,  located  in  the  twig  at  the  tip. 


48  EDUCATIONAL  HYGIENE 

This  common  stuff  we  may  call  the  germ  plasm.  It  is  be- 
cause the  successive  leaves  on  a  twig  are  developed  out  of 
the  same  germ  plasm  that  they  are  alike.  It  is  because 
father  and  son  are  developed  out  of  the  same  germ  plasm 
that  they  are  alike.  The  case  in  man  is  more  complicated, 
however,  in  that  a  loss  of  materials  and  an  addition  of  other, 
foreign  materials  is  made  to  the  germ  plasm  at  the  initia- 
tion of  each  new  individual  in  the  processes  called  matura- 
tion of  the  germ  cell  and  fertilization  or  union  of  gametes,  so 
that  strictly  the  son  is  only  a  younger  half-hroiher  to  his 
father  by  a  different  mother.  We  have  got  used  to  think- 
ing of  the  eggs  in  the  mother  as  hers.  Strictly  they  are  not 
hers  but  are  merely  a  part,  left  behind,  of  the  fertilized  egg 
out  of  one  part  of  which  she  developed.  The  rest  was  car- 
ried in  her  body,  protected,  warmed,  and  fed  by  that  body 
and  put  in  the  way  of  continuing  its  history,  reaching  back 
to  the  beginning  of  life  on  the  globe,  provided  that  "fertili- 
zation of  the  egg"  can  be  secured. 

When  we  think  what  a  history  that  germ  plasm  has  had, 
through  what  billions  of  accidents  of  not  being  continued  it 
passed  unscathed  to  the  present  day;  when  we  consider  how 
its  continuation  is  absolutely  determined  by  our  behavior; 
when  we  contemplate  the  wrong  that  we  should  do  society 
and  the  world  if,  through  our  neglect,  an  excellent  germ  plasm 
should  not  be  continued  for  another  generation,  then  we 
realize  dimly  the  magnitude  of  the  trusteeship  that  is  ours  in 
the  care  of  this  germ  plasm  that  we  carry.  Then  we  reahze 
the  heinousness  of  the  crime  of  poisoning  it  with  alcohol, 
or  of  rendering  it  impotent  through  the  access  of  venereal 
disease,  or  of  preventing  its  continuation  because,  forsooth, 
we  don't  want  to  be  bothered  with  the  care  of  the  new  soma 
that  might  arise  from  it  and  so  continue  this  germ  plasm  to 
the  next  following  generation.  The  germ  plasm  belongs  to 
society,  to  the  state,  and  to  injure  it  or  to  prevent  it  from  carry- 
ing out  its  manifest  destiny,  save  for  eugenical  reasons,  is  to 
be  unfaithful  to  one's  trusteeship,  is  to  commit  a  crime  against 


HEALTH  AND   HEREDITY  49 

society  and  the  state;  and  it  should  be  so  considered  by  the 
state. ^ 

Again,  strictly,  we  do  not  inherit  characteristics  from  the 
germ  plasm.  It  is  only  a  figure  of  speech  when  I  say  I  in- 
herited my  nose.  There  was  no  nose  in  the  germ  plasm. 
The  germ  plasm  carried  some  things  that  determined  that  I 
should  have  such  bones  and  cartilages  and  connective  tissues 
as  give  the  form  to  my  nose.  These  materials  in  the  germ 
plasm  we  call  determiners;  and  it  is  because  of  some  difference 
in  the  determiners  for  the  nose  in  my  germ  plasm  from  the 
nose  determiner  of  your  germ  plasm  that  I  have  a  different 
form  of  nose  from  you.  The  peculiarity  of  the  nose  determiner 
in  my  case  depends  upon  certain  differentials  in  the  determiner. 
Noses,  then,  have  their  distinguishing  characters  largely,  if 
not  chiefly,  by  virtue  of  certain  differentials  in  the  germ  plasm. 
We  have  our  hereditary  peculiarities  because  of  the  persist- 
ence, through  the  stream  of  germ  plasm  that  passes  down  the 
generations,  of  certain  differentials. 

Environmental  Modifications  of  Determiners. — We  in- 
herit, as  we  have  seen,  tleterminers.  The  determiner  is  not 
the  characteristic;  it  must  develop  to  produce  the  character- 
istic. Now,  the  course  of  any  development  is  not  definitely 
predetermined,  but  depends  upon  surrounding  conditions. 
Here  is  where  environment  plays  its  important  role  in  modi- 
fying the  development  of  the  determiner.  All  efforts  for  care 
of  the  pregnant  woman,  of  the  expectant  mother,  all  child- 
feeding,  milk-station  work,  all  parental  training,  all  school 
instruction,  religious  influences,  and  cultural  conditions  in 
general  are  brought  to  bear  to  secure  the  best  possible  develop- 
ment of  the  determiner  of  the  various  elements  of  the  phys- 
ical, intellectual,  and  emotional  make-up.  Good  culture  can 
do  much  to  insure  the  full  development  of  determiners  in  the 

'"Original  nature  comes  from  original  nature:  inheritance  is  from  germs 
to  the  germs.  Long  before  a  man  is  born,  the  germ-cells  that  will  thirty  years 
later  produce  his  children  are  set  off  apart.  They  do  not  come  from  him  as  a 
collection  from  his  total  make-up,  but  from  the  germs  that  produced  him." 

— Thorndike,  in  "Education,"  p.  206. 


50  EDUCATIONAL  HYGIENE 

fertilized  egg;  bad  conditions  may  prevent  the  full  develop- 
ment of  determiners;  but  the  best  conditions  cannot  cause  to 
develop  in  a  cliild  any  trait  the  determiner  for  which  is  ab- 
sent, just  as  rain  and  sunshine  and  manures  do  not  cause  a 
plant  to  arise  where  no  seed  has  been  planted.  Here  is  the 
clear  limit  to  the  power  of  environment. 

The  Combinations  of  Determiners. — Finally,  each  child  is 
derived  from  the  union  of  two  germ  plasms — of  two  bundles 
of  determiners — from  two  germ  cells.  In  the  two  bundles 
that  unite  there  are  many  determiners  that  are  the  same,  but 
there  are  probably  some  that  are  found  in  one  of  the  germ 
cells  and  not  in  the  other.  When  both  germ  cells  bring  to  the 
embryo  a  determiner  for  the  same  trait,  the  trait  may  be  said 
to  be  duplex.  When  only  one  germ  cell  supplies  the  deter- 
miner for  a  trait,  the  trait  in  the  developed  soma  is  simplex. 
If  neither  parent  supplies  in  his  germ  cells  the  determiner  for 
a  trait,  then  the  trait  does  not  develop  in  the  offspring. 

When  the  determiners  are  duplex  in  the  individual,  then, 
when  that  individual  forms  his  ripe  germ  cells,  every  one  of 
them  contains  the  determiner  for  the  trait.  When  an  in- 
dividual is  simplex  in  this  respect,  then,  when  the  germ  cells 
are  formed  in  such  an  individual,  half  of  them  possess  and  half 
of  them  lack  the  determiner.  If  the  individual  has  acquired 
from  neither  parent  the  determiner  for  the  trait,  then  in  none 
of  the  germ  cells  of  that  individual  will  a  determiner  be  found. 

This  abstract  conception  may  now  be  illustrated  by  an 
example,  and  I  choose  that  of  eye  color,  (i)  When  both 
parents  are  brown-eyed  and  belong  to  brown-eyed  stock,  so 
that  all  of  their  germ  cells  carry  the  determiner  for  brown 
iris  pigmentation,  then  all  of  the  children  that  arise  by  the 
union  of  such  germ  cells  will  have  the  determiner  for  brown 
iris  pigmentation  duplex.  (2)  If  one  parent  be  brown-eyed 
and  of  brown-eyed  stock,  whereas  the  other  is  brown-eyed 
but  simplex,  then  all  of  the  children  will  have  brown  eyes 
but  half  of  them  will  be  duplex  and  half  simplex  in  this  re- 
spect.    (3)  If  one  of  the  parents  be  duplex  brown-eyed  and 


HEALTH  AND   HEREDITY  5 1 

the  other  blue-eyed,  then  all  of  the  children  will  be  brown-eyed 
but  simplex.  (4)  If  both  parents  be  simplex  brown-eyed, 
then  one  in  four  of  the  children  will  be  duplex  brown- 
eyed,  two  simplex  brown-eyed,  and  one  in  four  will  be  blue- 
eyed.  (5)  If  one  parent  be  simplex  brown-eyed  and  the  other 
blue-eyed,  then  half  of  the  offspring  will  be  simplex  brown- 
eyed  and  half  blue-eyed.  (6)  If  both  parents  be  blue-eyed, 
then  all  of  the  children  will  have  blue  eyes. 

Health  and  Heredity. — ^We  are  now  in  a  position  to  take 
up  the  relation  of  heredity  to  health.  In  treating  of  this 
topic  I  propose  first  to  speak  of  the  relation  of  heredity 
(i)  to  the  physical  development  of  the  child,  (2)  to  the  mental 
development,  (3)  to  its  moral  development,  (4)  to  its  resist- 
ance to  physical  disease,  (5)  to  its  resistance  to  mental  disease, 
(6)  to  longevity} 

(i)  Physical  Development  and  Heredity.— That  the  course 
of  development  of  the  body  has  a  hereditary  basis  is  obvious 
from  a  vast  number  of  family  histories  that  have  been  studied. 
The  methods  of  inheritance  of  defects  in  physical  development 
are  of  three  types  so  far  as  known.  There  are  defects  due  to 
an  extra  determiner,  those  due  to  the  absence  of  some  deter- 
miner that  is  typically  present,  and  those  that  are  sex-linked. 
{a)  Physical  Defects  Due  to  an  Extra  Determiner  or  Deter- 
miners.— To  this  category  belong  certain  eye  defects.  Of 
these,  juvenile  cataract  is  one  of  the  commonest  and  most 
important.  This  consists  of  a  clouding  of  the  lens  of  the  eye 
and  has  a  pedagogical  importance  because  it  interferes 
greatly  with  vision  and  eventually  causes  practical  blindness. 
This  may  begin  to  appear  at  birth.  Nettleship  describes  the 
case  of  a  boy  who  showed  a  cataract  when  the  eye  was  first 
carefully  examined,  three  months  after  birth.  Usually,  how- 
ever, it  begins  later,  at  eight,  ten,  fifteen,  or  twenty-five  years, 
or  even  later.  If  now  the  family  history  be  studied,  it  will  be 
found,  practically  invariably,  that  one  parent  of  the  affected 

'See  Davenport's   "Heredity   in  Relation  to  Eugenics,"   and  Rosenau's 
"Preventive  Medicine  and  Hygiene." 


52  '  EDUCATIONAL  HYGIENE 

child  had  also  cataract  in  youth,  and  this  can  often  be  traced 
back  for  several  generations  without  a  break.  Unaffected 
descendants  of  affected  ancestors  do  not  have  affected  off- 
spring. 

Among  other  eye  diseases  that  fall  in  the  same  category 
are:  glaucoma,  or  the  distension  of  the  ball  of  the  eye  by 
excessive  production  of  internal  fluids;  retinitis  pigmentosa 
(usually),  which  is  a  degeneration  of  the  retina  that  leads  to 
irremediable  blindness;  and  night-blindness,  often  associated 
with  the  foregoing,  which  makes  it  hard  to  see  by  artificial 
light. 

Imperfections  in  the  development  of  the  male  genitaha 
fall  into  the  category  of  positive  imperfections  to  develop- 
ment; in  extreme  conditions  the  individual  is  a  ''hermaph- 
rodite," and  may  show  psychical  conditions  as  ambiguous  as 
his  physical.  Finally,  nearly  all  abnormalities  of  fingers  and 
toes  seem  to  belong  to  this  group,  including  polydactyHsm,  syn- 
dactyHsm  ("lobster-claw"),  brachydactyUsm  (or  two- jointed 
fingers),  double- join tedness  of  fingers,  and  crossed  or  hammer 
toe.    The  affected  persons  tend  to  reproduce  their  pecuUarity. 

(b)  Physical  Defects  Due  to  the  Absence  of  a  Determiner. — 
One  of  the  best  examples  of  this  class  is  defect  of  pigment,  as 
seen  in  albinos.  This  condition  is  usually  complete;  the 
spotted  condition  is  rather  rare  and  is  properly  not  albinism, 
and  seems  to  be  inherited  as  a  positive  character.  When  pig- 
ment is  lacking  the  hair  is,  including  that  of  the  eyelashes, 
white;  the  skin  is  of  a  clear,  translucent  pink;  the  retina  is 
devoid  of  pigment,  so,  as  seen  through  the  pupil,  the  back  of 
the  eye  looks  pink;  even  the  blue  of  the  iris  may  be  absent. 
Such  cases  usually  arise  from  consanguineous  marriages,  be- 
cause the  defect  has  to  be  carried  in  each  of  the  fused  germ 
cells. 

In  addition  to  albinism  there  is  some  reason  for  believing 
that  excessive  growth  in  stature,  congenital  deafness,  and 
cleft  palate  are  developmental  defects  that  are  due  to  the 
absence  of  each  of  one  or  more  determiners;  but  it  must  be 


HEALTH   AND   HEREDITY  53 

admitted  that  heredity  in  these  cases  seems  to  be  complex 
and  has  been  insufficiently  analyzed. 

(c)  Physical  Defects  Due  to  the  Absence  of  a  Sex- Linked 
Determiner. — Here  belongs,  first  of  all,  hemophilia,  or  inability 
to  coagulate  the  blood  after  a  wound.  The  so-called  "bleed- 
ers" are  apt  to  die  in  consequence  of  excessive  hemorrhages; 
so  that  this  defect  is  a  very  serious  one.  As  in  the  case  of 
other  sex-limited  qualities,  it  is  found  typically  only  in  males 
and  only  such  as  have  unaffected  parents,  but  the  trail  of 
the  defect  can  be  traced  through  the  female  line  to  some 
affected  male  ancestor.  No  affected  male  who  marries  a 
normal  woman  has  any  affected  children,  but  the  daughter 
of  such  will  have  half  of  her  sons  affected.  Atrophy  of  the 
optic  nerve  and  multiple  sclerosis  are  other  examples  of  this 
trait. 

(2)  Mental  Development  and  Heredity. — Heredity  plays 
a  great  part  in  the  mental  development  of  the  child  also; 
typically  by  the  absence  of  one  or  more  determiners  for  com- 
plete mental  development.  Thus,  there  is  much  evidence  that 
hereditary  imbecility  is  due  to  the  absence  of  one  or  more  de- 
terminers; for  two  parents  of  the  hereditary-imbecile  type 
have  typically,  if  not  always,  only  offspring  of  this  type.  In 
the  same  way  hereditary  epilepsy  seems  to  result  from  the 
absence  of  a  single  determiner  that  regulates  the  centres  that 
control  movements.  Cerebral  palsy  of  infancy  is  similarly 
due  to  a  defect.  Finally,  color-blindness  must  be  mentioned 
as  a  type  of  the  sex-linked  characters  that  belong  to  this 
category  and  whose  inheritance  follows  the  same  law  as 
hemophilia,  mentioned  in  the  last  paragraph. 

(3)  Moral  Development  and  Heredity. — Heredity  has 
important  relations  to  moral  development.  Studies  of  way- 
ward children  have  shown  that  bad  temper,  especially  of  the 
stormy,  outbursting  kind  (tantrums),  is  clearly  dependent  on 
a  positive  determiner;  the  trait  passes  without  break  from 
generation  to  generation.  Also  extreme  eroticism,  eroto- 
mania, is  inherited  in  similar  positive  fashion.     Many  other 


54  EDUCATIONAL  HYGIENE 

elements  of  wayward,  violent,  and  criminalistic  behavior 
have  a  clear  hereditary  basis,  even  though  the  exact  method 
of  inheritance  cannot  yet  be  given. 

(4)  Resistance  to  Disease  and  Heredity. — Inheritance  of 
resistance  or  susceptibiUty  to  disease  has  long  been  recog- 
nized, but  since  the  grand  developments  in  bacteriology  the 
old  theory  of  diathesis  (predisposition)  has  rather  fallen  into 
disrepute;  but  it  is  now  reviving  again.  Just  as  the  organs  of 
the  body  are  not  in  the  germ  plasm  as  such  but  merely  de- 
terminers or  differentials  of  them,  so  with  respect  to  disease. 
Susceptibility  as  opposed  to  resistance  is  due  to  one  or  more 
differentials  in  the  germ  plasm. 

In  some  cases  this  susceptibility  is  due  to  a  positive  de- 
terminer. Thus  the  tendency  to  form  fluid-filled  vesicles  in 
the  skin  after  the  shghtest  provocation  such  as  a  pressure  or 
a  scratch  (epidermolysis  bullosa)  is  a  trait  that  shows  itself 
in  the  first  month  of  life  and  it  is  strongly  hereditary.  It  is 
to  be  noted  that  the  bullae  are  not  formed  without  the  trauma; 
they  are  the  reaction  of  a  specially  susceptible  skin  to  a  sHght 
trauma.  Similarly  a  tendency  to  chronic  jaundice  runs  in 
certain  families  without  skipping  a  generation. 

In  other  cases,  and  these  seem  to  be  commonest  of  all, 
the  susceptibility  is  due  to  an  absent  determiner.  To  this 
class  belongs  in  all  probability  non-resistance  to  tuberculosis, 
and  to  the  causes  that  lead  to  catarrh:  here  also,  almost  cer- 
tainly, susceptibility  to  cancer.  Thus  lack  of  resistance  plays 
a  role  of  the  profoundest  importance  in  some  of  our  worst 
diseases. 

(5)  Resistance  to  Mental  Disease  and  Heredity. — In 
speaking  of  mental  breakdown  we  are  prone  to  find  its  cause 
in  some  sort  of  stress,  loss  of  a  close  relative,  disappointment 
in  love,  failure  in  business,  etc.  But  these  things  happen  to 
many  people  who  do  not  lose  their  mental  vigor.  Those 
who  thus  give  way  have  some  neural  defect,  some  lack  of 
mental  strength.  That  juvenile  dementia  is  due  to  an  actual 
lack  of  some  determiner  is  indicated  by  its  method  of  inherit- 


HEALTH  AND   HEREDITY  55 

ance.  If  both  parents  be  subject  to  it,  all  of  the  children  are. 
There  seems  to  be  a  Httle  more  doubt  about  the  conditions 
that  are  classified  as  manic-depressive. 

(6)  Longevity  and  Heredity. — That  longevity  has  a  he- 
reditary basis  cannot  be  doubted.  It  is  easy  to  find  frater- 
nities, even  of  large  size,  nearly  all  of  whose  members  have 
Hved  to  be  over  eighty  years  of  age  and  in  which  both  parents 
and  at  least  half  of  the  grandparents  had  reached  the  same 
advanced  age.  In  other  famiHes,  on  the  contrary,  most  if 
not  all  are  dead  by  fifty  years.  We  can  understand  this 
upon  the  principle  of  inherited  resistance  to  specific  diseases. 
A  body  that  is  resistant  to  tuberculosis,  to  catarrh  of  the 
respiratory  tract,  and  to  cancer  passes  unscathed  through 
the  most  dangerous  period  of  beginning  decline  of  the  bodily 
powers. 

The  foregoing  list  by  no  means  completes  the  roll  of  mor- 
bid, or  contrariwise  healthy,  conditions  that  have  a  hereditary 
basis,  hut  only  those  whose  method  of  inheritance  is  best  known. 
Many,  if  not  most,  serious  heart  troubles  that  date  from 
early  childhood  are  due  to  hereditary  malformations  or  bad 
positions  of  the  heart.  Harehp  and  cleft  palate,  multiple 
nipples,  hereditary  ataxy,  Friedrich's  disease,  amaurotic  family 
idiocy,  certain  edemas,  various  disorders  of  metaboHsm, 
rheumatism,  migraine,  dipsomania,  and  scores  of  other  con- 
ditions have  a  clear  hereditary  factor;  and,  conversely,  the 
absence  of  these  is  largely  due  to  some  hereditary  source  of 
strength  and  vigor.  An  early  breakdown  can  usually  be 
attributed  to  some  weakness  in  the  machine. 

Eugenics  and  Health.— The  wide-spread  absence  of  phys- 
ical and  mental  health  in  the  population  is  a  tremendous 
handicap  to  society.  Our  States  spend  over  $100,000,000 
annually  in  the  care  of  the  defectives  and  the  sick,  and  it 
may  be  conjectured  that  no  less  a  sum  is  lost  privately 
by  illness  of  one  sort  and  another,  due  to  inherited  lack  of 
resistance.  Not  only  is  there  a  huge  money  loss  but  a  loss  of 
labor  of  an  army  of  effective  persons  caring  for  defectives 


50  EDUCATIONAL  HYGIENE 

who  might  otherwise  be  engaged  in  some  constructive  work. 
The  consideration  of  all  of  these  facts  has  led  many  persons 
to  urge  that  attempts  be  made  by  education  and  by  state 
interference  to  diminish  the  heavy  reproduction  of  these 
mental  and  physical  weaklings.  This  is  the  practical  applica- 
tion of  eugenics,  which  on  its  theoretical  side  is  largely  the 
study  of  heredity  in  man. 

While  it  is  recognized  that  the  state,  by  segregation  of 
those  unfit  to  reproduce,  or  even  by  sterilization,  may  di- 
minish the  reproduction  of  the  grossly  unfit,  many  have  grave 
doubts  if,  by  education,  anything  can  be  done  to  influence 
marriage  selection.  In  this  doubt  the  present  writer  does  not 
share;  and  the  reason  for  his  optimism  is  that  scores  of  per- 
sons who  are  thinking  of  marrying,  others  who  are  interested 
in  another,  and  still  others  who  are  so  deeply  in  love  that 
they  declare  they  will  die  if  their  love  is  not  satisfied,  have 
written  to  him  to  know  if  the  contemplated  union  will  prob- 
ably result  in  healthy  offspring.  And  in  two  cases,  at  least, 
on  viewing  the  facts  of  heredity  as  displayed  by  a  graphic 
representation  of  their  own  statements,  the  proposed  marriage 
has  been  abandoned.  These  cases  were,  to  be  sure,  those  in 
which  there  was  home  opposition  on  eugenic  grounds  and  the 
writer  was  called  upon  to  act  as  referee.  I  mention  these 
facts  as  justification  for  my  contention  that  at  an  early  stage 
in  the  often  prolonged  process  of  falling  in  love  proper  in- 
struction may  avert  an  impending  ill-advised  match.  One 
great  difficulty  has  been  that  our  knowledge  of  the  inherit- 
ance of  traits  is  wofully  deficient.^ 

As  an  instrument  of  research  in  human  heredity  and 
eugenics  there  was  founded  in  October,  1910,  by  Mrs.  E.  H. 
Harriman,  at  Cold  Spring  Harbor,  Long  Island,  N.  Y.,  the 
Eugenics  Record  Ofhce.  This  office  seeks  to  fill  the  need  of 
a  clearing-house  for  data  on  human  heredity,  and  a  place 
where  studies  on  heredity  can  be  made.     This  office  seeks  to 

'See  chapter  on  "The  Hygiene  of  the  High  School,"  in  Johnston's  "The 
Modern  High  School,"  by  the  editor. 


HEALTH  AND   HEREDITY  57 

interest  persons  in  their  own  family  history  by  distributing, 
without  charge,  a  schedule  called  "Record  of  Family  Traits" 
to  those  who  agree  to  fill  it  out  for  their  own  family  and  return 
it  to  the  office — a  second  copy  being  sent  to  such  as  desire 
to  retain  it  for  their  own  use.  In  this  way  thousands  of  per- 
sons have  had  their  attention  directed  to  a  careful  considera- 
tion of  their  own  traits  and  the  distribution  of  these  traits 
throughout  their  family. 

The  appHcation  of  such  family  histories  is  very  varied. 
Many  teachers  have  suggested  that  every  pupil  on  entering 
a  school  should  bring  with  him,  filled  out,  such  a  schedule  so 
that  his  teachers  might  have  some  knowledge  of  his  hereditary 
background;  might  have  some  notion  of  the  probable  poten- 
tialities that  they  are  to  cultivate.  Every  teacher  learns, 
usually  at  the  end  of  the  semester,  about  his  student's  capac- 
ities, but  it  would  save  much  valuable  time  if  he  had  some 
inkling  of  this  at  the  very  beginning.  A  knowledge  of  the 
heredity  of  pupils  will,  of  course,  be  indispensable  in  any 
scientific  plan  of  vocational  and  hygienic  guidance.  Similarly 
the  family  history  would  be  of  great  advantage  to  the  gym- 
nasium director  in  prescribing  exercises  for  any  student,  and 
it  would  be  useful  in  the  infirmary  in  case  the  student  should 
fall  ill.  A  proper  recognition  of  the  facts  of  hereditary  poten- 
tialities would  be  of  assistance  in  all  aspects  of  a  student's 
training. 

To  facilitate  the  inquiry  as  to  the  desirability  of  a  given 
marriage  from  the  standpoint  of  health  of  the  children,  the 
Eugenics  Record  Office  distributes  a  schedule  called  "Index 
to  the  Germ  Plasm,"  in  which  may  be  recorded  parallel 
records  of  the  young  man  and  the  young  woman.  Such  a 
parallel  record  brings  into  clear  relief  the  family  inheritable 
traits  and  enables  the  expert  to  say  at  least  something  about 
probable  traits  of  children.  The  schedule  is  a  somewhat  diffi- 
cult one  to  fill  out,  but  already  scores  have  been  filled  out 
very  carefully  and  served  as  a  basis  for  a  clear  statement  of 
probable  results  of  the  given  combination  in  so  far  as  the 


58  EDUCATIONAL  HYGIENE 

nature  of  the  germ  plasm  is  truly  and  fully  set  forth  in  the 
schedule. 

By  such  means,  then,  the  health  of  the  next  generation 
may  be  made  better  than  that  of  this — not  merely  by  curing 
the  sick,  not  merely  by  following  the  "rules  of  hygiene," 
but  by  breeding  a  larger  proportion  of  children  who  shall  be 
in  the  less  need  of  the  rules  of  hygiene  because  their  bodies 
are,  by  nature,  highly  resistant  to  health-destroying  agencies. 


CHAPTER  IV 
THE    HOME    HYGIENE    OF    CHILDREN 

Parents'  Health  Responsibilities. — In  the  past  it  has  been 
a  too  common  habit  to  lay  the  blame  for  the  production  of 
many  of  the  physical  and  mental  handicaps  of  children  upon 
the  public  schools.  A  closer  study  of  actual  conditions,  how- 
ever, reveals  the  fact  that  the  home  plays  a  far  greater  part 
than  the  school  in  the  production  of  such  handicaps.  With- 
out the  close  co-operation  of  home  and  school  little  of  real 
value  can  be  developed  in  the  way  of  improving  the  health 
conditions  of  school-children.  In  this  chapter  an  attempt 
will  be  made  to  outline  those  points  which  parents  need  to 
understand  to  co-operate  successfully  with  the  school  in  the 
physical  improvement  of  children.  Parents  greatly  need  to 
learn  correctly  to  interpret  the  rather  plain  signs  of  common 
disorders  in  children. 

There  are  many  significant  habits  which  indicate  such 
disorders,  yet  these  are  frequently  either  quite  ignored  or 
misinterpreted.  Then  the  parent  must  also  remember  that 
symptorns  of  health  are  at  least  as  important  as  those  of 
disease,  and  that  many  things  which  to  some  seem  abnormal 
are  merely  normal  manifestations  in  the  development  of  the 
child.  Each  individual  child  requires  special  study,  for  there 
is  really  no  such  thing  as  an  average  child. ^  All  children  are 
in  one  sense  "exceptional." 

Wise  parents  should  not  make  the  common  mistake  of 
attributing  many  symptoms  to  one  cause,  but  should  often 
look  and  expect  to  find  several  such  causes.^ 

*  See  Thorndike's  book  on  "  Individuality." 

^  Parents  will  find  much  help  in  Professor  Ditman's  little  one-volume  cyclo- 
pedia on  "Home  Hygiene  and  the  Prevention  of  Disease"  (DufSeld). 

59 


6o  EDUCATIONAL  HYGIENE 

Heredity. — As  Doctor  Davenport  has  shown,  the  matter 
of  heredity  is  of  such  paramount  importance  in  any  serious 
study  of  children  that  it  deserves  some  discussion  before  all 
else,  and  this  is  of  special  interest  in  respect  to  a  considera- 
tion of  nervous  children.  Very  often  the  child  is  blamed  both 
at  school  and  at  home  for  matters  which  are  either  the  direct 
or  indirect  results  of  heredity  and  for  which  the  child  is  little, 
if  at  all,  responsible. 

In  the  home  study  of  the  child,  parents  can  do  no  better 
than  to  commence  with  a  careful  consideration  of  those  qual- 
ities which  they  themselves  possess.  Such  an  inquiry  often 
unfolds  and  explains  problems  which  otherwise  might  re- 
main unexplained,  and  which  would  therefore  be  difficult  to 
correct. 

The  child  is  a  small  mosaic  of  all  his  ancestors,  but  par- 
ticularly of  his  more  immediate  ones,  and  it  is  of  the  utmost 
importance  to  understand  as  far  as  may  be  just  what  ele- 
ments enter  into  his  make-up.  Why  parents  should  so  fre- 
quently ignore  the  rather  plain  manifestations  of  their  own 
undesirable  qualities  when  they  appear  in  their  children  in  a 
slightly  disguised  form  is  a  matter  hard  to  comprehend. 

"It  is  difficult  to  understand,"  says  Doctor  Leonard  G. 
Guthrie,  ''why  a  subject  so  important  to  the  welfare  of  the 
community  as  the  study  of  children  should  have  been  so 
long  neglected,"  and  one  might  add  that  it  is  still  more  diffi- 
cult to  understand  why  a  subject  so  important  as  the  study 
of  parenthood  suffers  from  yet  greater  neglect. 

In  the  schools  to-day  we  hear  and  see  much  of  the  nervous 
child,  but  how  often  is  it  understood  that  such  nervous,  and 
usually  irritable,  children  have  in  most  instances  nervous, 
irritable  fathers  or  mothers?  The  correction  of  nervous  dis- 
orders in  children  ought  often  to  begin  with  parents,  for  even 
with  a  bad  heredity  in  this  respect  much  good  may  be  accom- 
pHshed  if  the  child  can  be  relieved  of  what  is  nearly  always 
present  under  such  conditions,  namely,  an  unstable,  neurotic 
home  environment.    But  before  parents  can  successfully  study 


THE   HOME   HYGIENE   OF   CHILDREN  6 1 

their  own  nervous  tendencies  it  is  often  important  to  recognize 
the  early  nervous  manifestations  of  their  children. 

Description  of  the  Nervous  Child. — Doctor  Francis 
Warner,  in  his  "Study  of  Children,"  has  briefly  described  the 
nervous  type  of  child  perhaps  better  than  any  one  else,  when 
he  says: 

There  is  a  class  of  children  commonly  met  with  in  every  commu- 
nity, termed  nervous  children.  Such  are  apt  to  complain  of  headache, 
are  difficult  to  put  to  sleep,  they  talk  at  night,  and  grind  their  teeth, 
while  in  the  morning  they  are  tired  and  not  ready  for  breakfast.  They 
are  often  bright  enough  mentally,  and  affectionate  in  disposition,  but 
they  are  likely  to  be  irritable,  passionate,  and  too  emotional.  They 
are  the  children  who  arc  delicate  without  having  any  definite  disease; 
they  are  rarely  laid  up  with  a  definite  illness  but  they  are  not  strong; 
they  cannot  walk  far  without  getting  tired;  some  days  they  are  too 
tired  to  do  anything  and  must  rest;  capricious  in  appetite,  yet  some- 
times ravenous,  but  remaining  stationary  or  increasing  slowly  in  weight. 

The  general  balance  of  the  body,  as  the  child  stands,  is  usually 
asymmetrical,  with  the  head  slightly  drooped  and  inclined  to  one 
side;  while  the  spine  is  perhaps  bent  a  little  to  one  side,  with  unequal 
shoulders,  and  the  feet  unequally  planted. 

The  eyes  wander  much,  in  place  of  being  directed  to  objects. 
In  the  face  the  expression  may  be  somewhat  diminished,  with  ful- 
ness under  the  eyes  indicating  fatigue. 

When  the  hands  are  held  out  in  front,  asymmetry  in  balance  of 
the  arms  is  frequent,  the  left  hand  usually  being  held  lower.  The 
fingers  frequently  show  twitching  movements,  if  they  are  held  separate 
from  one  another  so  as  to  be  free  to  move. 

In  mental  habit  such  children  are  usually  quick  in  learning,  talk- 
ative, playful,  and  often  laughing. 

In  social  life  they  seek  one  another's  company  and  as  they  are  usu- 
ally imitative,  one  may  prove  a  source  of  mental  excitement  to  another. 

On  looking  further  at  such  a  child,  you  will  probably  find  that 
the  face  is  the  best  nourished  part  of  the  body.  The  limbs  are  thin; 
the  teeth  are  very  likely  flattened  at  their  tips  from  the  constant 
habit  of  tooth  grinding. 

These  nervous  children  are  very  difficult  to  feed:  the  appetite  is 
either  very  poor  or  it  is  capricious. 

We  may  further  add  to  this  accurate  description  of  Doctor 
Warner's  by  stating  that  nervous  children  are  often  restless, 


62  EDUCATIONAL  HYGIENE 

inordinately  active,  busy  to  no  very  definite  purpose;  their 
emotional  natures  are  often  unduly  developed,  and  under 
very  poor  control.  Laughter  and  tears  are  always  near  the 
surface.  Affection,  anger,  sorrow,  and  joy  are  not  very  well 
differentiated.  They  are  inclined  to  selfishness,  fond  of  at- 
tracting attention,  quick  to  give  offense,  but  quicker  to  re- 
sent it  in  others.  At  home  children  of  this  type  are  usually 
very  badly  disciplined,  and  indeed  such  children  often  furnish 
a  pretty  fair  index  to  the  character  of  one  or  both  parents. 
Such  parents  probably  use  very  little  discretion  in  matters 
of  disciphne.  They  cannot  bear  to  see  the  child  suffer  and 
consequently,  since  it  rarely  meets  with  resistance,  it  wishes 
to  have  everything  it  sees.  It  wants  every  whim  and  caprice 
satisfied.  Such  a  child  soon  becomes  a  perfect  young  tyrant, 
and  he  is  not  only  a  source  of  annoyance  to  others  but  he 
defeats  his  own  happiness  also,  for  he  never  learns  the  habit 
of  self-control.  Most  of  the  neurasthenic  adults  who  go 
about  in  the  search  for  unearned  happiness  have  passed  through 
a  childhood  similar  to  that  just  described,  and  indeed  we  may 
safely  state  that  their  nervous  disorder  is  often  largely  the 
direct  result  of  faulty  early  methods  of  training.  Nervous 
children  need  definite  and  rigid,  but  at  the  same  time  kind, 
home  discipline,  and  in  many  instances  such  training  might 
well  begin  with  one  or  both  parents. 

"Such  children,"  says  Doctor  I.  A.  Abt,  "should  be  taught 
to  endure  pain  with  some  degree  of  self-control,  to  respect  the 
rights  of  others,  to  obey  just  commands,  to  acquire  some  de- 
gree of  composure,  to  live  regular  lives,  to  be  unselfish,  and 
to  love  the  good,  the  true,  and  the  just.  Particularly  high  in 
these  qualities  is  the  love  of  truth.  He  who  is  true  to  himself 
and  others  is  rarely  overtaken  with  a  disorder  whose  striking 
characteristics  are  exaggeration  and  dissatisfaction." 

Environment. — It  is  a  difficult  matter  always  to  draw  a 
sharp  line  between  the  influences  of  heredity  and  those  of 
environment,  for  such  influences  are  constantly  overlapping. 
Even  a  child  with  an  originally  well-balanced  nervous  system 


THE  HOME  HYGIENE  OF  CHILDREN         63 

may  well  become  irritable  and  generally  unstable  through  the 
influence  of  a  bad  nervous  environment.  On  the  other  hand, 
njany  a  child  with  a  faulty  heredity  or  a  distinctly  nervous 
predisposition  has  developed  into  a  normal  life  through  the 
influence  of  a  favorable  en\dronment.  Environment  has  much 
to  do  wath  deciding  the  character  and  stabiUty  of  the  child. 
It  acts  every  hour  of  the  day,  tending  to  form  the  habits, 
lines  of  acting,  and  modes  of  thought. 

Parents  control  the  bodies  and  minds,  hearts  and  souls  of  their 
children,  not  only  through  hereditary  traits  handed  down  from  their 
ancestors,  but  also  by  what  they  themselves  do  and  think. 

Example  and  imitation  guide  the  child  in  thought  and  action.^ 

A  bad  school  en\aronment  is  capable  of  doing  much  harm 
to  any  child,  but  the  best  of  school  environments  can  do  Httle 
to  offset  the  constant  and  pernicious  influence  of  an  unwisely 
conducted  home.  It  is  too  much  to  ask  of  the  school  that  it 
re-educate  a  child  whose  first  five  or  six  years  of  life  have  run 
in  wrong  channels,  or  that  it  correct  in  a  few  hours  each  day 
the  influence  of  daily  faulty  habits  of  the  home. 

Children  surrounded  day  after  day  by  a  home  environment 
little  or  not  at  all  adapted  to  character  formation  furnish 
most  of  the  nervous  pupils  of  our  schools. 

Some  Common  Functional  Nervous  Disorders  of  Chil- 
dren.— ^Most  of  the  nervous  disorders  of  children  are  found 
in  the  child  of  neurotic  temperament  whose  general  character- 
istics have  already  been  described. 

These  disorders  are  usually  one  or  more  of  the  following 
group: 

{a)  Habit  spasms. 

{h)  Chorea. 

(c)   Stammering  and  some  other  speech  defects. 

{d)  Morbid  fears. 

(e)  General  nervous  fatigue. 

In  a  discussion  such  as  this,  which  of  necessity  must  be 
*  Oppenheim. 


64  EDUCATIONAL  HYGIENE 

strictly  limited,  it  will  only  be  possible  very  briefly  to  outline 
a  few  of  the  leading  symptoms  in  each  of  the  groups  men- 
tioned, with  the  expectation  that  the  parent,  after  recogniz; 
ing  the  situation,  will  seek  proper  medical  aid. 

Habit  Spasms. — These  are  characterized  by  quick,  invol- 
untary, peculiar  movements.  They  may  be  easily  recognized 
by  the  following  description  by  Guthrie: 

A  series  of  lightning-like  blinks  or  nods  or  sudden  turns  of  the 
head  aside.  The  eyebrows  may  be  elevated  or  corrugated  or  the  upper 
lids  may  be  raised  several  times  in  quick  succession,  as  in  a  munching 
rabbit,  or  the  nose  may  be  wrinkled  and  the  nostrils  expanded  or  con- 
tracted, whilst  half  a  dozen  or  more  little  ineffectual  sniffs  are  pro- 
duced, or  a  variety  of  grunts  and  queer  guttural  noises  are  heard. 

The  characteristic  of  all  these  simple  tics  is  that  they  suddenly 
come  and  go,  and  each  form  will  commonly  give  place  to  another. 
It  is  seldom  that  more  than  one  trick  or  antic  is  present  at  a  time. 
In  a  more  complicated  form  of  habit  spasm  or  tic  the  child  will  often 
perform  the  most  astounding  tricks. 

Such  habit  spasms  seem  often  to  be  a  family  habit  and 
no  doubt  usually  represent  a  neurotic  family  temperament. 

Scolding,  nagging,  or  punishment  on  the  part  of  parents 
only  serves  to  increase  this  trouble  in  a  nervous  child,  and 
prompt  advice  should  be  sought  from  a  competent  physician. 
The  habits  are  usually  curable  under  proper  conditions. 

Chorea. — Chorea,  or  St.  Vitus's  dance,  is  often  confused 
Vvdth  habit  spasms,  and  this  is  most  unfortunate,  as  it  is  of  a 
much  more  serious  nature. 

It  ought  to  be  recognized  early,  but  as  a  matter  of  fact 
it  is  seldom  recognized  by  parents  and  teachers  until  it  is 
well  advanced. 

Any  child  should  be  suspected  of  chorea  who  has  some  or 
all  of  the  following  habits: 

(a)  Extreme  restlessness. 

(b)  Purposeless  motions. 

(c)  InabiHty  to  hold  pencils,  books,  knife,  fork,  etc., 
securely. 

(d)  Falling  down  or  stumbling  easily  and  frequently. 


THE  HOME  HYGIENE  OF  CHILDREN         65 

The  spasmodic  symptoms  include  muscular  spasms  of 
various  parts  of  the  body,  such  as  contortions  of  the  face, 
jerky  movements  of  the  head,  shoulders,  arms,  and  legs.  In 
general,  the  muscular  spasms  include  larger  groups  of  muscles 
than  in  habit  spasms. 

The  trouble  is  often,  if  not  always,  closely  associated 
with  diseased  tonsils  and  rheumatism,  and  in  many  instances 
the  heart  is  affected. 

Early  and  systematic  treatment  is  required,  and  the  child 
should  be  removed  from  school  both  for  his  own  good  and 
for  the  good  of  other  pupils,  some  of  whom  are  very  likely  to 
imitate  the  grimaces  and  other  habits  until  it  becomes  a  more 
or  less  fLxed  habit  on  themselves. 

Children  with  this  disorder  require  rest  in  bed,  quiet, 
regular  Hfe,  nourishing  food,  and  proper  medical  treatment. 

Stammering  and  Stuttering. — Stammering,  which  is  caused 
by  a  "spasmodic  arrest  of  utterance,"  and  stuttering,  which 
consists  in  "spasmodic  repetition  of  initial  syllables/'  are 
both  often  associated  with,  if  not  caused  by,  a  neurotic  tem- 
perament. The  basis  of  these  speech  defects  lies  in  "defective 
nervous  control."  ^ 

Doctor  Still  states  that  the  determining  cause  may  be 
some  depressing  illness,  or  a  shock,  or  some  form  of  physical 
irritation.  Sometimes  it  appears  after  diseases  such  as  scarlet 
fever,  diphtheria,  or  whooping-cough.  Fright  may  initiate 
the  disorder,  and  so  may  an  accident.  In  some  cases  it  ap- 
parently originates  through  imitation. 

Most  children  who  suffer  from  these  defects  of  speech  are 
of  superior  intelligence,  and  are  usually  sensitive  and  of 
highly  organized  disposition. 

The  treatment  of  speech  defects  requires  special  attention 
unless  they  are  quite  mild  in  nature,  and  specialists  should 
therefore  be  consulted. 

Above  all,  it  should  be  remembered  that  nagging,  scold- 
ing, or  fault-finding  in  the  cases  of  children  who  stammer  or 
stutter  will  produce  great  injury  to  the  child. 
» See  Bibliography. 


06  EDUCATIONAL  HYGIENE 

As  Professor  Terman  well  says,  "the  stuttering  child 
presents  a  tragedy  to  which  a  majority  of  teachers  and  parents 
are  strangely  blind,  and  at  home  the  onset  of  the  disease  is  a 
signal  for  impatience  and  reproof  on  the  part  of  parents. 
The  result  is  often  the  formation  of  morbid  habits  of  thought 
and  failure  in  school  work."  ^ 

Morbid  Fears. — Nervous  children  are  rather  prone  to 
morbid  fears  of  various  sorts,  and  in  some  instances  these 
fears  cause  an  intense  suffering,  Httle  or  not  at  all  understood 
by  parents. 

Doctor  Guthrie  well  says  that  the  earHest  indications  of 
fear  should  be  recognized  and  should  meet  with  sympathy, 
encouragement,  explanation,  and  removal  of  its  causes  if 
possible — never  with  badinage  or  indifference.  Of  all  emo- 
tions, he  says,  it  is  the  one  most  calculated  to  produce  lasting 
effects  upon  a  neurotic  child. 

These  morbid  fears  include  all  sorts  of  things  which  the 
child  is  quite  unable  to  explain.  Often  through  shame  he 
hides  his  fears  until  they  become  almost  an  obsession  or  a 
fixed  idea.  Many  of  the  '^  queer  ^^  habits  of  children  may  be 
explained  by  these  suppressed  fears.  Sometimes  the  child 
is  made  by  them  to  appear  stubborn,  or  he  may  develop  un- 
truthfulness, embarrassment,  or  a  variety  of  other  pecuHar- 
ities  so  often  misinterpreted. 

Such  fears  include,  among  many  others,  fear  of  the  dark 
to  an  extreme  degree;  fear  of  sounds  such  as  bells,  the  wind, 
whistles,  etc.;  fear  of  space,  of  death,  of  sickness,  of  crowds; 
of  future  punishment,  of  stories  of  a  grotesque  or  otherwise 
fanciful  nature;  fear  of  certain  real  people,  or  of  witches. 
Some  children  develop  fears  of  shadows,  of  the  forest,  of  water, 
of  Hghtning,  or  even  of  the  most  common  and  ordinary  kinds 
of  objects.  Not  infrequently  rehgious  fears  develop  in  a 
sensitive  child  which  fairly  paralyze  the  joy  of  living.  The 
normal  child  will  not,  in  fact,  be  very  religious,  for  religion  is 

'  Parents  and  teachers  may  well  read  Terman's  "The  Hygiene  of  the  School 
Child,"  and  Hoag  and  Terman's  "Health  Work  in  the  Schools." — Ed. 


THE   HOME   HYGIENE   OF   CHILDREN  67 

to  such  children  something  quite  beyond  their  childish  com- 
prehension, and  something  in  which  they  are  therefore  not 
much  interested.  An  intense  rehgious  zeal  in  a  child,  as 
also  in  some  adults,  is  in  itself  a  symptom  of  a  nervous  dis- 
order, not  an  evidence  of  desirable  piety. 

Corporal  punishment  is  always  of  doubtful  value,  but  in 
the  case  of  nervous  children,  and  particularly  those  with  mor- 
bid fears,  it  must  be  unhesitatingly  condemned. 

Unnatural  remorse  for  youthful  misdemeanors,  real  or 
imaginary,  is  often  seen  in  nervous  children,  and  an  *' ex- 
treme anxiety  to  be  strictly  truthful"  is  again  not  an  evidence 
of  moral  rectitude  so  much  as  of  morbid  nervous  instabiUty. 
Worry  and  apprehension  are  also  sure  signs,  in  children  at 
least,  of  the  neurotic  temperament. 

In  childhood  many  danger  signs  of  future  mental  unbal- 
ance may  often  be  discovered  by  those  able  to  interpret 
them,  and  through  this  discovery  there  may  be  avoided  in 
many  instances  not  only  the  neuroses  of  adults  but  also 
actual  insanity.  The  prevention  of  insanity  is  at  last  coming 
to  interest  the  public  nearly  as  much  as  the  prevention  of 
other  forms  of  disease. 

General  Nervous  Fatigue. — Fatigue  is  so  common  and  is 
produced  in  such  a  variety  of  ways  that  a  full  discussion  of 
it  at  this  time  is  quite  impossible.  Parents  should  remem- 
ber that  the  normal  child  does  not  fatigue  easily  and  that 
when  he  does  tire  he  recuperates  rapidly  after  sleep. 

The  chronically  fatigued  child  needs  medical  advice. 
Play  and  other  physical  activities  are  normal  to  the  young 
and  anything  more  noticeable  than  ordinary  weariness  in 
children  calls  for  careful  consideration. 

In  real  cases  of  fatigue  there  is  an  actual  poisoning  of 
the  central  nervous  system  through  the  absorption  of  fatigue 
poisons. 

As  Woods  Hutchinson  says,  "whenever  the  blood  is  im- 
poverished below  a  certain  degree  or  becomes  loaded  with 
fatigue  poisons  or  other  waste  products  above  a  certain  point, 


68  EDUCATIONAL  HYGIENE 

then  the  nervous  system  proceeds  to  make  itself  felt.  The 
practical  point  is  that  a  fatigued  child  is  a  sick  child  and  the 
cause  or  causes  of  such  sickness  must  be  discovered." 

Sometimes  this  is  worry,  or  abnormal  fears,  or  it  may  be 
due  to  digestive  disorders,  or  wrong  food,  or  too  little  sleep, 
or  various  forms  of  nervous  overpressure.  But  whatever 
the  causes  are,  the  child  has  .a  right  to  the  protection  from 
future  troubles  of  the  same  sort  which  only  a  careful  study  of 
his  case  will  afford. 

Common  Errors  in  Children's  Diet.^ — In  children  of  the 
school  age  it  is  very  common  to  notice  those  who  are  suffer- 
ing from  some  form  of  malnutrition.  Such  children  usually 
have  the  following  appearance:  they  are  thin,  pale,  and  nerv- 
ous; often  the  lymph  glands  of  the  neck  are  enlarged;  some- 
times the  gums  and  lining  of  the  eyelids  are  quite  colorless; 
headache  is  rather  common,  and  either  diarrhea  or  consti- 
pation is  the  rule.  A  careful  history  of  such  a  case  will  usually 
bring  out  the  information  that  the  child  is  very  capricious  in 
appetite,  that  he  has  acquired  fussy  food  habits;  that  he  is 
irritable,  and  perhaps  sleeps  poorly  or  at  least  is  restless  at 
night.  Not  many  of  such  cases  have  their  basis  in  any  very 
definite  disease,  although  some  are  tubercular,  as  would  be 
clearly  demonstrated  by  the  proper  tests  (Von  Pirquet  and 
others). 

These  children  are,  in  the  majority  of  instances,  accord- 
ing to  the  writer's  rather  extended  experience,  neurotic,  and 
their  fussiness  about  food  is  only  one  of  many  other  nervous 
symptoms. 

Careful  questioning  brings  to  light  the  fact  that  the  child 
will  not  eat  the  ordinary  vegetables,  with  perhaps  the  excep- 
tion of  potato;  that  he  is  inordinately  fond  of  sweets;  that  he 
abhors  fat,  with  the  possible  exception  of  butter.  Sometimes, 
but  less  often,  the  child  will  eat  certain  vegetables  in  excess, 

•  In  the  preparation  of  this  section  the  writer  acknowledges  his  obligations 
to  Doctor  Adele  Jaffa  and  Doctor  Langley  Porter.  See  also  the  chapter  on 
"School  Feeding  of  School  Children,"  by  Doctor  Bryant. 


THE   HOME   HYGIENE   OF   CHILDREN  69 

to  the  exclusion  of  meat  or  other  forms  of  proteids,  and  often 
he  will  utterly  refuse  to  drink  milk.  In  the  main,  however, 
the  malnourished  school-child  is  addicted  to  excessive  carbo- 
hydrates (starches  and  sugars),  and  consequently  suffers  from 
starch  indigestion.  This  form  of  intestinal  indigestion  usually 
leads  to  headache,  gas  formation,  diarrhea,  or  less  often 
constipation.  He  is  really  a  victim  of  one  form  of  auto-in- 
toxication, or  self-poisoning.  With  the  cause  or  causes  once 
discovered,  the  cure  is  often  rather  easy.  It  goes  without 
saying  that  the  fault  is  in  many  instances  the  parents'  rather 
than  the  child's.  Faulty  food  habits  have  been  condoned 
if  not  actually  encouraged,  until  the  unfortunate  child  has 
become  a  victim  of  his  vicious  habits.  Neither  scolding, 
nagging,  nor  persuasion  will  avail  much,  but  about  the  only 
reasonable  course  to  pursue  is  for  the  parent  to  learn  what 
the  proper  diet  is  for  a  child  at  different  ages  and  then  see  to 
it  that  he  gets  the  diet  suited  to  his  needs.  Place  the  proper 
foods  before  the  child  and  then  let  him  eat  or  go  without.  Or- 
dinarily these  foods  will  consist  of  just  what  the  normal 
adult  members  of  the  family  eat,  with  the  exception  of  tea 
and  coffee.^  When  such  a  child  really  becomes  hungry  he  will 
eat  good  food  of  the  usual  varieties.  Firm  but  kind  and 
patient  discipline  will  always  be  necessary  to  secure  satis- 
factory results. 

Eating  between  meals  is  to  be  discouraged,  at  least  until 
the  child  has  established  normal  food  habits.  But  once  he 
has  done  so,  there  can  be  no  valid  objection  to  giving  him 
real  food  when  he  is  truly  hungry.  It  must  not  be  forgotten, 
however,  that  real  food  does  not  consist  of  candies  and  other 
sweets,  and  that  in  any  case  it  must  be  given  in  reasonable 
moderation.  As  for  water,  neither  child  nor  adult  can  drink 
too  much,  provided  only  that  it  is  not  taken  to  wash  down 
unmasticated  food.  The  proper  mastication  of  food  is  a 
habit  which  should  be  acquired  very  early,  but  it  will  usually 
be   observed    that   most   children,  malnourished    as  well  as 

>  More  than  50  per  cent  of  school-children  drink  coffee,  and  often  to  excess. 


70  EDUCATIONAL  HYGIENE 

others,  need  definite  instruction  in  this  respect.  The  ques- 
tion will  naturally  arise  at  this  point  as  to  what  is  the  proper 
diet  for  children  of  different  ages.  To  answer  this  question 
adequately  would  be  quite  beyond  the  limitations  of  this 
chapter,  but  as  a  very  general  guide  the  following  suggestions 
are  given: 

For  a  Child  Four  Years  Old. — The  child  is  to  have  not 
more  than  three  meals  a  day.  Not  more  than  one  pint  of 
milk  should  be  given  to  drink,  another  pint  may  be  given 
in  the  form  of  junket  or  custard  or  milk  soup  during  the  day. 

Breakfast. — An  egg,  with  some  thin  shces  of  bacon; 
crisp  toast  and  butter;  some  apple-sauce  or  stewed  fruit  or 
ripe  fruit  peeled;  if  the  child  is  constipated,  give  honey, 
stewed  prunes,  or  fruit  jelly  instead  of  butter  on  the  toast; 
to  replace  some  of  the  toast,  give  such  cereals  as  Force, 
Shredded  Wheat,  Triscuit,  or  Toasted  Rice  Biscuit. 

Midday  Meal. — Small  portion  of  broth  (veal,  mutton,  or 
chicken)  or  milk  soup  with  vegetables  pureed  into  it;  small 
amount  of  simply  cooked  meat,  no  fried  meat;  at  first,  meat 
should  be  finely  chopped  and  mixed  with  baked  potato  or 
boiled  rice  or  fine  Italian  paste,  upon  which  may  be  put  some 
blood  gravy  or  broth;  white  fish  may  be  given  occasionally; 
a  green  vegetable  which  has  been  put  through  a  fine  sieve, 
preferably  cauliflower,  green  peas,  green  beans,  spinach,  or 
asparagus  tips;  crisp  crackers  or  toast  with  butter.  Dessert: 
plain  pudding,  or  stewed  fruit,  or  junket,  or  blanc-mange,  or 
plain  sponge-cake  or  stale  lady-fingers  with  fruit  juice. 

Supper. — Milk  soup  with  some  vegetables  pureed  into  it, 
or  some  bread  and  milk,  or  junket,  or  custard;  occasionally 
ice-cream  may  be  given  if  it  is  of  known  quahty.  Milk  jelly 
or  egg  jelly  or  fruit  jelly  made  according  to  the  recipe. 

Foods  for  Older  Children. — After  a  child  reaches  the  age 
of  five  he  may  ordinarily  eat  the  same  food  as  adults,  if  it  is 
well  selected,  with  the  exception  of  tea  and  coflfee. 

Desirable  foods  include:  clean  milk,  well-cooked  cereals, 
crisp  bacon,  fish,  broiled  steak,  soups,  soft  eggs,  thin  toast, 


THE  HOME   HYGIENE   OF  CHILDREN  7 1 

bread  and  butter,  corn  bread,  crackers,  fruit  of  nearly  all 
kinds,  both  fresh  and  cooked,  especially  baked  apples  and 
stewed  prunes.  Fat  in  some  form  is  absolutely  necessary. 
This  is  best  taken  in  the  form  of  butter  or  oUve  oil.  Often  it 
is  necessary  to  disguise  the  fat  in  some  special  palatable  form. 

Undesirable  foods  include :  fried  meats,  veal  in  any  form, 
salt  pork,  tea,  coffee,  hot  bread,  doughnuts  and  hot  cakes 
(except  in  strict  moderation),  all  greasy  foods,  in  general  all 
fried  foods.  Bananas  are  rather  hard  to  digest  unless  baked. 
Fruits  with  many  seeds,  such  as  raspberries  and  blackberries, 
are  not  desirable  for  young  children. 

Meals  consisting  of  a  deficient  variety  must  be  avoided, 
such  as  coffee  and  bread,  bread  and  syrup,  potato  and  bread, 
or  meals  which  include  only  starchy  foods.  There  is  no  objec- 
tion to  water  with  meals  unless  it  is  used  to  wash  down  in- 
sufffciently  masticated  food,  but  iced  water  is  best  avoided 
except  in  very  hot  weather. 

School-Children. — In  considering  the  question  of  how 
best  to  feed  school-children,  it  must  not  be  forgotten  that  the 
period  of  school  life  extends  over  a  number  of  years,  and  that 
in  the  schoolhouse  we  invariably  find  children  of  different 
stages  of  growth  and  development  and  children  with  very 
widely  different  needs.  It  would  be  impossible  for  any  di- 
rections, however  lengthy,  to  cover  properly  or  adequately 
the  requirements  of  all  children,  even  at  the  same  stage  of 
their  lives,  with  their  widely  varying  tastes  and  idiosyn- 
crasies and  their  special  constitutional  tendencies.  No  diet 
list,  however  carefully  chosen,  could  be  used  with  good  results 
for  all  children  of  any  one  age,  much  less  for  children  of  all 
ages. 

The  only  hope  of  a  proper  solution  to  this  many-sided 
problem  lies  in  creating  in  the  minds  of  those  people  who  have 
the  catering  in  charge,  an  intelligent  understanding  of  the 
uses  of  the  various  foods,  and  trusting  the  rest  to  their  dis- 
crimination. Many  rules  of  dietetics  are  only  of  service 
when  appHed  by  the  person  who  has  had  experience  with 


72  EDUCATIONAL  HYGIENE 

the  particular  child  in  question,  and  possesses  a  thorough 
understanding  of  its  special  needs.  Only  wide  general  prin- 
ciples are  universally  applicable. 

Kinds  of  Foods. — The  scientific  principles  which  underlie 
the  proper  selection  of  foods  are  few  and  easily  understood. 
Chemical  analysis  has  shown  us  that  all  foods,  no  matter 
how  simple  or  how  complex  they  may  appear,  contain  only 
four  classes  of  materials.  Each  class  has  many  subdivisions 
containing  an  infinite  variety  of  chemical  compounds.  But 
nothing  has  been  found  that  cannot  be  classified  under  these 
four  heads.  Two  of  these  are  mineral  matter  and  water, 
which  are  not  necessary  to  consider  in  our  present  discussion. 
That  leaves  us  only  two  main  classes  of  nutrients  to  under- 
stand and  to  deal  with — the  nitrogenous  group  and  the  non- 
nitrogenous. 

The  question  is  naturally  asked:  "Of  what  use  is  this 
classification?  In  what  way  does  it  help?"  The  answer  is 
at  once  plain  when  we  consider  that  these  two  classes  have 
entirely  distinct  and  separate  offices  to  perform  in  the  body. 
The  protein  or  nitrogenous  group  builds  tissues — the  bones, 
muscles,  nerves,  internal  organs,  etc.  It  supplies  material 
both  for  the  building  of  new  tissues,  as  in  growth,  and  for  the 
repair  of  the  old.  The  non-nitrogenous  group  furnishes  heat 
to  keep  the  body  warm  and  energy  or  power  with  which  to 
perform  our  work.  This  material  may  be  stored  up  in  the 
body  for  future  use  in  the  form  of  fat,  but  can  never  be  used 
to  build  real  or  deep  tissues.  Fat  in  the  body  is  Hke  coal  in 
the  basement,  ready  to  be  converted  into  heat  and  energy. 
Our  need  of  it  after  we  have  accumulated  enough  fat  to  round 
out  our  frames  is  in  direct  proportion  to  the  weather  and  to 
the  amount  of  energy  we  expend  in  both  voluntary  and  in- 
voluntary functions.  The  little  girl  who  sits  in  a  warm  room 
and  reads  and  sews  does  not  need  as  much  as  her  brother  who 
plays  ball  in  the  cold  winter  air. 

That  brother  is  the  best  example  of  a  healthy  creature  in 
need  of  plenty  of  nourishing  food,  that  we  could  well  find, 


THE   HOME   HYGIENE   OF   CHILDREN  73 

especially  if  he  is  in  his  teens.  There  is  every  kind  of  a  call 
for  food  that  could  be  found  under  normal  conditions.  Who 
else  in  the  family  is  growing  so  quickly,  who  else  lengthen- 
ing out  and  widening  every  bond  and  tissue  of  the  body? 
The  baby  of  the  family  may  be  doing  that,  but  she  is  not 
studying  or  exercising,  neither  is  she  under  nerve  strain. 
The  father  may  be  using  his  brain  in  his  work  and  may  be 
under  nerve  strain,  but  he  is  not  growing  and  may  not  be 
exercising  very  much.  Rarely  indeed  do  we  find  a  human 
creature  whose  demands  for  food  materials  are  so  many  and 
so  urgent  as  those  of  the  boy  in  his  teens. 

If  the  problems  involved  in  the  proper  feeding  of  a  grow- 
ing boy  be  solved  first,  the  results  may  be  modified  for  other 
children,  up  and  down  the  line,  according  to  their  ages  and 
conditions,  and  their  individual  needs.  We  have  come  to 
know  a  great  deal  about  the  food  for  the  first  period  of  rapid 
growth,  that  of  infancy,  since  the  chemical  analysis  of  mother's 
milk  has  furnished  us  with  a  perfect  model  upon  which  to 
base  our  selection  of  substitutes  when  the  natural  food  fails 
us.  But  the  second  period,  that  comes  early  in  the  *' teens," 
is  not  yet  so  generally  understood. 

During  these  years  of  adolescence,  when  Nature  is  making 
every  effort  to  develop  and  round  out  the  perfect  individual, 
she  needs  all  the  help  we  can  give  her.  She  cannot  build  if 
we  do  not  supply  her  with  material,  but  she  can,  and  often 
does,  build  one  part  at  the  expense  of  another.  It  is  a  com- 
mon thing  to  hear  a  mother  say,  with  reference  to  a  child, 
that  he  "outgrew  his  strength."  Translated,  that  expression 
means  that  the  child  did  not  get,  or  was  not  able  to  use, 
sufficient  food  material  to  supply  the  needs  of  the  entire 
organism. 

It  is  the  second  and  last  chance  that  Nature  has  to  remedy 
defects  in  the  constitution,  and  she  makes  a  desperate  effort 
to  accomplish  it.  The  results  of  improper  feeding  at  this 
time  cannot  be  easily  remedied.  It  is  often  a  case  of  "now  or 
never,"  and  the  work  that  is  not  done  in  this  second  formative 


74  EDUCATIONAL  HYGIENE 

period  of  life  may  not  be  done  at  all.  Weak  spots  in  the 
building  will  always  remain  weak  spots,  and  we  should  not 
run  any  risks  at  this  time.  Many  of  the  nervous  symptoms 
usually  observed  during  the  period  of  adolescence  are  not 
necessary  or  normal.  The  nerves  suffer  from  insufficient  and 
improper  nourishment,  as  well  as  from  other  wrong  and  un- 
hygienic conditions,  during  the  early  "teens." 

The  Kind  of  Food  Needed. — When  the  importance  of 
proper  nutrition  is  once  fully  realized,  the  first  question  asked 
is:  "How  can  we  supply  it — what  kind  of  food  does  the 
child  need?"  The  answer  is  very  plain.  He  needs  all  kinds, 
and  in  sufficient  quantities. 

At  first  glance  it  may  appear  that  no  real  directions  have 
been  given  for  the  dietary  of  a  growing  child.  "Feed  him 
everything.  He  eats  everything  now."  But  perhaps  a  second 
and  more  careful  glance  will  disclose  errors.  True,  there  is 
no  one  great  radical  change  advocated,  but  it  is  the  accumula- 
tion of  all  the  little  things  that  makes  the  real  difference. 
Nature  works  slowly.  In  order  to  help  her  we,  too,  must  work 
slowly  and  patiently  with  carefully  thought-out  meals,  con- 
scientiously persisted  in  for  years,  if  we  expect  to  see  results. 
Some  apparently  slight  change  made  in  each  meal  three 
times  a  day  for  three  hundred  and  sixty-five  days  in  the  year 
would  make  a  great  difference  in  the  end. 

Suppose,  for  instance,  it  were  decided  to  add  "growing 
material  to  the  dinner,"  other  than  the  meat.  Suppose  the 
meat  soup  were  replaced  occasionally  by  a  bean  or  pea  soup 
or  by  one  of  the  various  milk  soups,  and  that  on  other  days 
the  potatoes  were  replaced  by  rice  or  macaroni  and  peas 
used  more  frequently  than  other  vegetables,  and  that  on 
others  the  pie  were  replaced  by  custard  or  soft  home-made 
candy,  would  not  that  alone  make  considerable  difference  at 
the  end  of  the  year? 

And  if  for  breakfast  oatmeal  were  used  instead  of  wheat 
or  wheat  foods,  breakfast  cheese  for  those  who  do  not  eat 
meat  or  eggs,  milk  or  cocoa  instead  of  coffee,  milk  toast  in- 


THE   HOME   HYGIENE   OF   CHILDREN  75 

stead  of  dry  toast,  etc.,  would  not  the  sum  total  of  the  year's 
breakfasts  count? 

The  Lunch. — The  meal  that  usually  requires  the  most 
radical  reconstruction  is  the  lunch.  Between  the  children 
that  rush  home  and  swallow  a  hasty  bite  of  unsuitable  material 
and  hasten  back  for  fear  of  being  late,  or  else  to  play  with 
the  other  children,  and  those  who  carry  a  cold  lunch  composed 
of  food  that  would  not  furnish  very  much  nourishment,  even 
if  it  were  not  difficult  to  digest,  there  remain  probably  only 
a  small  percentage  of  children  whose  lunches  are  suited  to 
their  needs.  This  is  a  great  drawback  in  many  cases,  for  it 
is  often  the  one  meal  where  individual  requirements  can  be 
most  easily  attended  to.  To  shght  one  meal  out  of  three  is 
to  slight  a  very  large  portion  of  the  child's  opportunities  for 
nourishment. 

The  lunch  can  never  be  considered  alone.  It  must  of 
necessity  depend  largely  upon  what  is  given  for  the  other  meals 
of  the  day.  It  is  really  not  a  difficult  task  to  make  one  meal 
complementary  to  the  others  when  the  habit  of  mind  is  once 
estabhshed.  Having  acquired  a  permanent  mental  picture 
of  the  food  groups  and  knowing  the  special  requirements  of 
the  child,  it  becomes  an  easy  matter  to  arrange  a  lunch  of 
nourishing  materials  not  supplied  by  the  other  meals. 

Does  he  eat  heartily  of  meat  at  night  and  perhaps  have 
some  for  breakfast?  The  lunch  should  contain  "non-meat 
protein."  Does  he  prefer  the  vegetables  and  dessert  at  dinner  ? 
Give  him  meat  at  noon.  Do  the  other  members  of  the  family 
object  to  oil  or  fat?  See  that  the  growing  boy  gets  peanut 
butter  or  mayonnaise  sandwiches,  etc.,  for  his  lunch.  Is  his 
breakfast  light?  His  lunch  should  then  be  very  hearty.  Is 
he  tired  at  dinner-time  and  sleepy  ?  His  most  nourishing  meal 
should  be  at  noon.  Does  he  refuse  eggs  for  breakfast?  He 
may  relish  and  digest  them  well  for  lunch,  and  thus  it  goes. 
It  would  be  impossible  to  cover  the  ground  of  the  various 
elements  involved  in  the  decision. 

In  general,  the  lunch,  as  well  as  the  other  meals,  should  be 


76  EDUCATIONAL  HYGIENE 

as  simple  as  possible  in  order  to  supply  the  required  nourish- 
ment. The  work  of  handling  the  quantity  and  kind  of  food 
needed  to  build  up  the  physical  frame  and  keep  the  organism 
in  good  running  order  is  quite  enough  strain  on  the  digestive 
organs,  without  hampering  them  with  unnecessarily  compli- 
cated or  diflEicult  dishes.  As  a  rule,  made  dishes,  fried  food, 
"warmed-overs,"  smoked  and  salted  meats,  thickened  gravies, 
etc.,  should  not  often  be  given,  even  to  the  healthy  child,  and 
never  to  one  whose  digestion  is  weak.  Food  that  is  difficult 
of  digestion  may  often  be  handled  perfectly  on  occasions,  when 
frequent  repetitions  would  cause  disastrous  results.  It  must 
never  be  forgotten,  in  this  connection,  that  "what  is  one 
man's  meat  is  another  man's  poison,"  and  careful  observation 
is  the  only  sure  guide. 

Main  Points  of  Feeding. — The  main  points  to  keep  in 
mind  may  be  summarized  as  follows: 

Be  persistent  in  using  foods  from  each  group. 

Be  sure  to  use  plenty  of  "growing  material"  without  go- 
ing to  an  extreme  with  meat. 

In  using  meat  substitutes  remember: 

(a)  That  milk  is  the  most  valuable  one  to  use  if  it  agrees, 
and  that  skim-milk  is  just  as  rich  in  growing  materials  as 
whole  milk. 

(b)  That  eggs  come  next  in  order. 

(c)  That  nuts  must  be  ground  or  very  well  chewed  in  order 
to  be  properly  digested  and  assimilated. 

(d)  That  soup  meat  has  all  the  growing  material  left  in 
it,  and  none  of  the  deleterious  elements,  and  is  a  cheap  and 
excellent  food  and  can  be  made  into  appetizing  dishes  for 
breakfast  or  lunch. 

(e)  That  oatmeal,  macaroni,  rice,  and  gluten  flour  have 
more  growing  material  than  potatoes  or  white  flour. 

(/)  That  in  using  nuts,  cheese,  and  beans  the  question  of 
individual  digestion  must  dictate  the  choice. 

In  comparing  the  prices  of  the  different  foods,  we  should 
consider  the  amount  of  nourishment  they  contain  as  well  as 
the  price  per  pound. 


THE   HOME   HYGIENE   OF   CHILDREN  77 

Eating  between  meals  should  only  be  allowed  where  it  is 
prompted  by  hunger  and  not  by  a  desire  for  goodies.  Only 
easily  digested  foods,  as  crackers  and  fruit,  etc.,  should  be 
given  at  such  times. 

The  nourishment  should  be  fairly  well  distributed  among 
the  three  meals,  and  not  crowded  mainly  into  the  dinner. 

The  weekly  dietary  should  contain  considerable  variety, 
but  the  single  meal  not  too  great  a  mixture. 

Study  the  effects  of  combinations  before  discarding  any 
food  from  the  diet  list. 

Never  crowd  nourishment  nor  risk  indigestible  food  on 
occasions  of  excitement  or  fatigue. 

After  indulgence  in  an  unusually  heavy  or  taxing  meal 
see  that  the  next  one  is  unusually  simple. 

When  protein  is  added  to  the  dinner  for  the  sake  of  the 
children,  the  "grown-ups"  may  eat  less  of  the  meat.  The 
necessity  for  careful  mastication  is  a  lesson  that  children  can- 
not be  taught  too  early. 

If,  in  spite  of  reasonable  food  habits,  a  child  remains 
badly  nourished,  one  must  seek  for  deeper  causes,  in  which 
the  aid  of  a  skilful  physician  will  ordinarily  be  required. 
Perhaps  the  child  has  a  local  form  of  tiihercidosis  or  is  a 
sufferer  from  malaria  (in  malarious  countries);  perhaps  he  is 
suffering  from  fatigue,  which  again  may  be  caused  by  a 
great  variety  of  conditions;  or  he  may  have  adenoids,  or 
diseased  tonsils,  or  require  circumcision.  But  in  most  cases 
careful  attention  to  the  bowels,  to  fresh  air,  good  food,  plenty 
of  sleep,  to  firm  discipline  and  wholesome  and  interesting  play 
exercises,  will  solve  the  problem  of  the  malnourished  school- 
child. 

Ventilation. — It  would  seem  that  no  particular  attention 
need  be  called  to-day  to  the  necessity  for  good  ventilation 
in  the  home.  The  following  figures,  however,  taken  from  the 
writer's  personal  data,  will  demonstrate  that  ventilation  has 
as  yet  not  received  the  attention  it  deserves  in  a  great  many 
families. 


78  EDUCATIONAL  HYGIENE 

Of  68 1  children  questioned  in  fifteen  Minnesota  cities,  385, 
or  a  little  over  50  per  cent,  sleep  in  unventilated  bedrooms. 
In  Chisholm,  Minn.,  of  425  children  questioned,  237,  or 
about  50  per  cent,  confessed  to  no  bedroom  ventilation. 
In  another  Minnesota  city,  of  272  children,  176,  or  about 
64  per  cent,  have  no  ventilation  in  the  bedroom. 

These  figures  correspond  closely  with  those  obtained  by 
the  writer  in  other  places.  Even  in  Berkeley,  California, 
where  the  climate  is  mild,  it  appears  that  about  25  per  cent 
of  school-children  are  denied  fresh  air  at  night. 

Poor  ventilation  affects  the  health  not  so  much  because 
of  chemical  changes  in  the  air  breathed  in  a  close  room,  but 
mainly  because  in  such  rooms  there  is  abundant  opportunity 
for  infection  with  various  contagious  diseases.  Yet  any  one 
who  has  enjoyed  the  privilege  of  sleeping  out  of  doors,  or  in 
an  open-air  room,  knows  the  exhilaration  which  is  sure  to 
follow,  and  such  people  invariably  notice  the  ill  effects  of  a 
sudden  change  to  indoor  sleeping.  Poor  ventilation,  in  some 
way  not  altogether  understood,  reduces  general  vitality,  as 
well  as  resista,nce  to  specific  infections,  but  it  may  be  said 
that  these  results  are  due  largely  to  a  high  degree  of  humid- 
ity and  lack  of  movement  of  air  currents. 

It  ought  not  to  be  necessary  to  affirm  that  fresh  air,  day 
or  night,  injures  no  one,  not  even  the  most  delicate;  that,  on 
the  other  hand,  it  is  one  of  the  chief  remedies  for  the  cure  of 
tuberculosis,  pneumonia,  neurasthenia,  as  well  as  some  less 
definite  general  disorders. 

Headache. — That  headache  is  a  common  disorder  of  chil- 
dren is  clearly  shown  by  figures  taken  frcm  the  writer's  data. 

In  Owatonna,  Minn.,  24  per  cent  of  570  children  were 
found  to  be  sufferers  from  chronic  headache,  that  is,  headache 
at  least  as  often  as  two  or  three  times  every  week,  and  in 
many  cases  every  day.  In  thirteen  other  Minnesota  cities 
1,070  children  were  questioned  and  of  these  23.9  per  cent 
were  discovered  to  have  frequent  headache. 

Other  figures  give  similar  results,  and  it  is  therefore  safe 


THE   HOME   HYGIENE   OF   CHILDREN  79 

to  say  that  about  one-quarter  of  the  children  of  school  age 
are  afflicted  with  much  headache. 

The  reasons  for  this  rather  serious  handicap  are  not  en- 
tirely clear,  but  in  the  main  it  may  be  said  that  it  is  usually 
due  to  one  or  more  of  the  following  conditions: 

(i)  Constipation. 

(2)  Eye-strain. 

(3)  Poor  ventilation  of  home  or  school. 

(4)  Fatigue. 

(5)  Auto-intoxication  or  intestinal  indigestion. 

The  main  causes  once  being  understood,  it  is  usually  not  a 
difficult  matter  to  correct  and  control  them. 

Constipation  calls  for  careful  inquiry  into  proper  diets, 
and  adequate  and  abundant  use  of  drinking-water. 

Eye-strain  calls  for  a  visit  to  the  oculist  and  the  use  of 
properly  fitted  glasses.  Do  not  patronize  opticians  for  \asion 
examinations. 

Bad  air  should  not  be  tolerated  in  any  home  or  school  in 
any  climate  under  any  conditions. 

Fatigue  needs  careful  investigation.  The  child  may  be 
overstrained  nervously  cither  at  home  or  at  school,  and  in 
either  case  the  advice  of  an  intelligent  physician  will  be  needed. 

Auto-intoxication  is  ordinarily  due  to  starch-indigestion 
or  other  diet  errors,  or  to  chronic  constipation. 

In  respect  to  constipation,  one  should  understand  that 
the  use  of  cathartics  except  as  temporary  expedients  is  to  be 
strictly  condemned.  Most  cases  of  constipation  may  be  rather 
easily  corrected  by  the  use  of  a  mixed  diet  including  some 
coarse  foods  and  plenty  of  water,  combined  with  vigorous 
exercise.  Massage  and  other  special  exercises  of  the  abdominal 
muscles  are  often  useful. 

Disorders  of  the  Eyes,  Ears,  Nose,  and  Throat. — These 
disorders  are  very  serious  and  important,  but  cannot  be  given 
extended  discussion.  Parents  may  well  consult  Terman's 
''The  Hygiene  of  the  School  Child"  or  other  good  books  on 
these  vital  topics. 


8o  EDUCATIONAL  HYGIENE 

Attention  may,  however,  be  called  to  the  fact  that  fre- 
quent sore  throat  is  an  almost  infallible  sign  of  diseased 
tonsils;  that  rheumatism,  tonsiUtis,  and  St.  Vitus's  dance  are 
closely  associated;  that  adenoids  cause  mouth  breathing, 
crooked  teeth,  nasal  voice,  earache  and  discharge,  and  even 
running  ear,  and  deafness;  that  peculiar  postures  of  the  head, 
red  eyes,  crossed  eyes,  painful  eyes,  and  granular  lids  are  often 
caused  by  defects  of  vision.  Blurring  of  the  print  and  double 
vision  are  sure  indications  of  serious  eye  trouble.^ 

The  parent  should  also  be  reminded  that  defects  of  vision 
require  the  best  skill  of  a  reliable  ocuHst  and  that  the  ''opti- 
cians" are  usually  very  unreliable  in  their  eye  work. 

The  Teeth. — At  least  65  per  cent  of  children  between  five 
and  twelve  years  of  age  have  seriously  defective  teeth.  Often 
the  proportion  is  much  greater. 

Defects  of  the  teeth  are  not  only  offensive  to  the  aesthetic 
sense,  but  they  produce  many  bad  results  to  the  general 
health  both  directly  and  indirectly.  It  is  only  necessary  to 
state  here  that  the  first  teeth  require  just  as  careful  attention 
as  the  second,  and,  what  is  more  important  but  not  as  well 
understood,  that  decay  of  the  teeth,  both  first  and  second,  is 
largely  preventable  by  proper  hygienic  attention.  Preventive 
dentistry  is  far  more  important  and  much  less  expensive  than 
corrective  dentistry.  Deformities  of  teeth  and  jaws  should  be 
corrected  early  and  not  allowed  to  go  uncorrected  until  the 
bones  of  the  face  are  completely  developed.  This  is  a  point 
which  even  some  dentists  and  physicians  seem  not  fully  to 
understand. 

Conclusion. — A  very  great  deal  of  attention  is  paid  by 
the  national  and  local  governments  and  by  farmers  every- 
where to  the  proper  upbringing  of  hogs,  cattle,  horses,  sheep, 
and  the  like.  Millions  of  dollars  are  annually  spent  to  pro- 
mote the  health  and  proper  nurture  of  these  domestic  brutes, 

» Teachers  will  find  much  help  in  Cornell's  "Health  and  Medical  Inspection 
of  School  Children,"  and  in  the  author's  "Health  Index  of  Children,"  and 
Hoag  and  Terman's  "Health  Work  in  the  Schools." 


THE    HOME   HYGEEXE    OF    CHILDREN  8 1 

and  a  technical  science  has  been  developed.  ISIany  farmers 
rear  their  live  stock  better  than  they  do  their  own  boys  and 
girls.  City  parents  are  about  as  ignorant.  We  bespeak  for 
the  children  the  earnest  attention  and  studious  care  of  their 
parents.  The  hygiene  of  children  may  prove  as  interesting 
to  learn  as  bridge  whist  or  the  prevention  of  hog  cholera. 


CHAPTER    V 

PUBLIC  CO-OPERATION  FOR  SCHOOL-HEALTH 
AGENCIES 

The  Necessity  for  Public  Co-operation. — The  reasons  for 
asking  public  aid  in  the  development  of  school  hygiene  arise 
partly  from  the  conditions  under  which  knowledge  is  dif- 
fused and  partly  from  the  nature  of  our  democratic  institu- 
tions. The  discoveries  of  new  applications  of  scientific  prin- 
ciples are  first  made  by  individuals,  and  they  spread  to  other 
individuals  and  groups  only  through  the  slow  process  of 
publication  in  periodical,  pamphlet,  or  book.  The  use  of 
vacuum-producing  machinery,  for  example,  for  the  removal 
of  dirt  from  floors,  is  a  process  which  was  known  to  a  few 
some  time  before  it  reached  school  officials  generally,  and 
doubtless  there  are  some  who  even  yet  are  not  well  informed 
about  it.  The  latest  word  in  ventilation  has  reached  probably 
only  the  immediate  circles  which  surround  the  scientists  who 
are  working  upon  this  problem.  Since  municipal  depart- 
ments do  not  ordinarily  provide  facilities  for  gaining  infor- 
mation, school  officials  are  obliged  to  depend  upon  outside 
agencies  for  much  of  the  data  regarding  the  most  recent 
methods  if  they  would  keep  abreast  of  the  ever-advancing 
waves  of  health  knowledge.  But  this  is  only  a  minor  occasion 
for  seeking  outside  co-operation. 

The  Inertia  of  Democratic  Institutions. — Since  among 
democratic  institutions  modification  of  function,  theoretic- 
ally and  practically,  generally  results  from  the  impact  of 
public  sentiment,  the  adoption  of  new  methods  must  proceed 
much  more  slowly  in  a  democracy  than  it  does  in  a  mon- 
archical form  of  government.     But  if  the  knowledge  of  new 

82 


PUBLIC  CO-OPERATION  83 

hygiene  methods  spreads  slowly,  a  process  even  more  dila- 
tory is  the  assumption  of  such  methods  as  regular  functions 
by  our  public  institutions.  An  illustration  is  found  in  the 
case  of  school  medical  inspection.  In  tliis  country  its  in- 
ception took  place  in  Boston  in  1894,  and  in  191 1,  according 
to  statistics^  compiled  by  the  Russell  Sage  Foundation,  only 
443  cities,  or  43  per  cent  of  the  1,038  cities  reporting,  had 
adopted  medical  school  inspection.  And  of  the  443  only  102 
had  put  in  school  nurses,  and  only  69  were  employing  school 
dentists. 

Again,  boards  of  education,  like  other  governmental  bodies, 
are  not  only  slow  in  initiating  novel  methods  but  they 
are  also  slow  in  extending  them  to  all  parts  of  the  system. 
For  example,  many  cities  have  established  some  open-air 
schools  but  few  if  any  have  as  yet  made  adequate  provision 
for  all  the  anemic  or  pre-tubercular  children  now  attending 
their  classes.  The  explanation  is  to  be  found  in  the  fact  that 
boards  of  education  cannot  move,  even  when  the  legal  author- 
ity is  clear,  without  adequate  funds,  and  the  appropriation 
of  funds  is  ultimately  dependent  upon  public  approval. 
Since  school  officials  are  Hmited  in  their  power  to  arouse  public 
sentiment  in  favor  of  new  machinery,  they  are  obliged  to  de- 
pend upon  assistance  from  outside  agencies.  These  can  co- 
operate both  in  piecing  out  the  partially  adopted  activity 
and  in  developing  the  public  support  necessary  to  place  it 
upon  an  entirely  adequate  basis. 

The  Service  of  Criticism. — It  sometimes  happens  that 
medical  inspection  which  has  been  long  maintained  becomes 
inefficient.  The  school  authorities  may  suspect  the  existence 
of  unsatisfactory  conditions  and  yet  not  have,  or  be  in  the 
position  to  obtain,  the  evidence  necessary  for  their  correction. 
Here  again  is  afforded  an  opportunity  for  some  friendly  ex- 
ternal organization  to  carry  on  an  investigation  which,  be- 
cause of  its  foreign  auspices,  will  be  considered  more  impartial 
than  an  investigation  carried  on  by  the  board  of  education 
J  "Medical  Inspection  of  Schools,"  Gulick  and  Ayres,  p.  15. 


84  EDUCATIONAL  HYGIENE 

itself.  Again,  in  the  administration  of  hygiene  activities 
overlapping  sometimes  occurs,  and  thus  a  condition  is  brought 
about  which  can  be  remedied  only  by  a  third  party.  Only 
under  rare  circumstances  can  one  department  co-ordinate  its 
work  with  that  of  another  without  the  intervention  of  an 
unbiassed  umpire. 

Public  Co-operation  Increasing.— In  the  early  days  when 
leadership  in  school  matters  was  more  largely  left  in  the  hands 
of  prominent  citizens,  often  men  of  learning  and  standing  as 
educators,  the  co-operation  of  outside  agencies  was  not  only 
not  sought  but  even  considered  meddlesome.  With  the  in- 
creasing public  concern  regarding  child  welfare,  however, 
and  with  the  development  of  larger  initiative  on  the  part  of 
the  school  ofiicials  themselves,  a  different  order  has  come 
about.  To-day  the  school  reports  from  the  more  enterprising 
cities  are  replete  with  acknowledgments  of  indebtedness  to 
outside  agencies  for  various  kinds  of  valuable  assistance. ' 

The  Differentiation  of  the  Public. — For  the  purposes  of 
this  chapter  the  pubhc  is  considered  to  include  all  those  per- 
sons, and  private  bodies  which  are  not  under  the  control  of 
the  school  authorities.  This  public,  to  which  school  officials 
may  look  for  co-operation,  is  divided  into  individuals  and 
voluntary  organizations,  and  it  is  from  the  latter  bodies 
that  the  most  efficient  help  ordinarily  comes.  The  reason 
for  this  latter  fact  is  that  voluntary  organizations  represent 
and  give  expression  to  particular  interests.  In  the  act  of 
formation  itself  a  selection  is  automatically  made  of  those 
individuals  who  are  either  specially  interested  or  proficient 
in  the  activity  for  the  performance  of  which  the  group  was 
originally  called  together.  The  voluntary  society  is,  indeed,  a 
tentative  variation  in  the  structure  of  the  social  organism 
whereby  certain  of  its  elements  combine  to  perform  a  new 
function.  If  this  special  activity  prove  to  have  a  preserva- 
tive value  society  nourishes  it,  provides  it  with  bone  and 
sinew,  and  finally  articulates  it  with  its  other  fixed  institu- 
tions. 

•See  Cabot's  "Volunteer  Help  to  the  Schools." 


PUBLIC   CO-OPERATION  85 

The  Varieties  of  Private  Organizations. — When  grouped 
according  to  function  the  various  voluntary  and  quasi-public 
associations  to  which  school  officials  may  resort  for  health 
assistance  fall  into  seven  fairly  distinct  classes,  although  there 
is  considerable  overlapping,  many  bodies  carrjdng  on  activ- 
ities which  fall  into  two  or  three  different  categories. 

(i)  The  first  group  is  the  one  upon  whose  achievements 
all  the  others  are  dependent.  It  is  composed  of  the  organiza- 
tions which  develop  new  knowledge.  Their  workers  are 
scientists  who  are  working  in  the  van  of  advancing  civiliza- 
tion. They  include  such  bodies  as  the  Rockefeller  Institute, 
the  Carnegie  Foundation,  United  States  Bureau  of  Health 
Service,  faculties  of  medical  colleges,  and  other  associations 
which  are  composed  of  physicians,  sanitary  engineers,  and 
research  specialists  in  chemistry,  physics,  and  the  biological 
sciences. 

(2)  The  next  group  is  composed  of  the  bodies  whose  ex- 
perts develop  through  statistical  methods  the  facts  regarding 
the  existence  of  disease,  the  data  of  which  show  the  need  of 
improved  health  methods.  Such  a  body  is  the  Committee 
of  One  Hundred  on  National  Vitality  of  the  American  Asso- 
ciation for  the  Advancement  of  Science.  In  this  field  also  the 
various  insurance  companies  are,  through  their  actuarial  de- 
partments, doing  most  important  work. 

(3)  In  the  third  class  fall  the  organizations  which  inves- 
tigate the  various  methods  by  which  scientific  principles  of 
hygiene  are  put  into  effect.  They  examine  the  results  ob- 
tained under  different  forms  of  pubKc  administration  and 
make  their  researches  available  in  pubHshed  reports.  Among 
the  organizations^  performing  this  function  may  be  men- 
tioned the  National  Association  for  the  Study  and  Preven- 
tion of  Tuberculosis,  the  Russell  Sage  Foundation,  the  Life 
Extension  Institute,  the  National  Association  for  the  Study 
and  Prevention  of  Infant  Mortality,  and  the  United  States 
Public  Health  Service. 

'  For  a  more  comprehensive  list  of  these  various  organizations  see  "  Educa- 
tional Problems,"  by  G.  Stanley  itall,  Chapters  XI  and  XII. 


86  EDUCATIONAL  HYGIENE 

(4)  Associations  for  propaganda,  which  stimulate  and 
direct  campaigns  for  the  adoption  of  hygiene  activities,  con- 
stitute the  next  class.  Some  of  these  have  already  been  named 
in  the  preceding  category,  since  they  perform  both  of  these 
functions.  A  notable  instance  is  to  be  found  in  the  national 
and  local  bodies  which  are  pushing  the  fight  against  tubercu- 
losis. Other  examples  are  the  Playground  and  Recreation 
Association  of  America,  the  Woman's  Christian  Temperance 
Union,  the  General  Federation  of  Women's  Clubs,  National 
Conference  of  Charities  and  Correction,  and  similar  organi- 
zations.^ 

(5)  The  local  charitable  and  philanthropic  organizations, 
medical  and  dental  societies,  women's  clubs,  chambers  of 
commerce,  and  social  settlements  indicate  the  character  of 
the  next  class.  These  bodies  assist  by  promoting  the  estab- 
lishment of  hygiene  activities  in  local  institutions  and  by  ad- 
ministrative co-operation  in  incipient  and  inadequate  sys- 
tems. They  are  often  the  local  groups  through  which  the 
national  bodies  mentioned  in  the  preceding  category  perform 
their  work. 

(6)  Bodies  such  as  the  Public  Education  Association  or  the 
Bureau  of  Municipal  Research  which  do  local  research  work 
and  assist  not  only  in  the  strengthening  of  municipal  depart- 
ments but  also  endeavor  to  help  in  the  co-ordination  of  their 
activities,  comprise  this  group. 

(7)  The  last  group  is  composed  of  mothers'  clubs,  parent- 
teacher  societies,  ward  improvement  and  taxpayers'  associa- 
tions, and  other  bodies  of  citizens  which  maintain  a  receptive 
attitude  toward  health  information.  These  are  the  groups 
through  which  school  authorities  and  other  interested  bodies 
can  accomplish  a  diffusion  of  health  facts  so  as  to  develop  a 
supporting  environment  for  the  school  hygiene  activities. 

Information  about  Hygiene  Methods. — The  task  of  keep- 
ing in  touch  with  the  latest  school  hygiene  data  is  greatly 

»  See  Report  of  the  Commissioner  of  Education,   1912,  vol.  I,  "Typical 
Health  Teaching  Agencies  of  the  United  States,"  by  F.  B.  Dresslar,  pp.  299-358. 


PUBLIC   CO-OPERATION  87 

facilitated  for  school  officials  nowadays,  by  the  vast  numbers 
of  bibliographies  and  the  pamphlets  of  the  propagandistic 
organizations,  and  the  various  government  bulletins  which 
the  libraries  are  compiHng  and  collecting.  The  Federal 
Bureaus  of  Labor,  Education,  and  Children,  and  the  United 
States  PubUc  Health  Service,  are  constantly  sending  out 
pamphlets  bearing  upon  health  topics.  But  the  school  super- 
intendent has  not  only  to  keep  himself  informed;  for  tht 
successful  carrying  out  of  his  plans  it  is  necessary  that  the 
members  of  the  board  of  education  and  the  principals  and 
teachers  constituting  his  staff  should  likewise  be  well  informed. 
For  this  education  in  health  methods  within  the  school  sys- 
tem much  help  can  be  obtained  from  various  volunteer  or- 
ganizations. Lecturers  may  be  obtained  from  local  medical 
and  dental  societies,  and  the  staffs  of  the  various  propagan- 
distic organizations  working  in  the  health  field.  Many  of  these 
societies  have  lantern-slides  or  motion-pictures  which  can  be 
borrowed  for  public  meetings.  The  platform  discussions  may 
also  be  supplemented  by  carefully  chosen  and  tactfully  dis- 
tributed pamphlets. 

Information  should  be  sought,  however,  not  only  concern- 
ing the  most  improved  health  methods  in  other  cities,  but 
facts  should  also  be  obtained  about  the  sanitary  conditions 
in  the  superintendent's  own  system,  as  without  this  informa- 
tion thoroughly  efficient  administration  cannot  be  maintained. 
These  data  the  superintendent  can  to  a  certain  degree  obtain 
for  himself;  it  all  depends  upon  the  research  facihties  at  his 
command.  Often  he  is  obliged  to  call  upon  some  outside 
agency  either  for  assistance  in  carrying  on  an  investigation 
or  to  take  entire  charge  of  one.  Since  in  the  latter  case, 
through  the  mere  bringing  of  a  voluntary  organization  into 
intimate  contact  with  the  school  system  a  certain  proportion 
of  the  outside  pubUc  is  caused  to  become  vitally  concerned 
about  school  conditions,  this  topic  affords  an  appropriate 
transition  to  the  next  subject  that  requires  our  consideration. 

Creating  Public  Sentiment. — The  importance  of  seeking 


88  EDUCATIONAL  HYGIENE 

aid  from  outside  organizations  having  a  large  and  influential 
membership  in  the  task  of  making  sanitary  surveys  is  immedi- 
ately seen  when  it  is  realized  that  the  facts  as  to  bad  conditions 
are  of  little  value  unless  they  can  be  followed  up  by  adminis- 
trative changes  which  will  remedy  and  prevent  the  recurrence 
of  the  objectionable  conditions.  When  the  members  of  the 
woman's  club,  for  example,  go  about  from  school  to  school 
filling  out  a  sanitation  or  other  questionnaire,  they  actually 
enter  the  environment  in  which  the  children  of  the  commu- 
nity spend  a  large  portion  of  their  days.  If  this  environment 
is  not  healthful  they  are  immediately  filled  with  an  ardent 
desire  to  change  it,  and  thus  a  vast  amount  of  public  senti- 
ment is  automatically  created  and  set  to  spreading. 

Miss  Elsa  Denison's  "Helping  School  Children" — a  most 
suggestive  treatment  of  the  whole  subject  of  public  co-opera- 
tion— describes  in  Chapters  VII  and  VIII  many  kinds  of 
assistance  which  women's  organizations  are  rendering  school 
officials.  Mention  is  made  of  the  investigation  of  the  Boston 
pubhc  schools  by  a  branch  of  the  Association  of  Collegiate 
Alumnae,  which  resulted  in  the  formation  of  a  new  school 
code;  also  of  the  survey  performed  by  the  Arundell  Club  in 
Baltimore,  and  by  the  Pubhc  Education  Association  in  Provi- 
dence. The  extensive  questionnaire  used  by  the  New  Jersey 
Federation  of  Women's  Clubs  in  its  State-wide  study  of  school 
conditions  is  also  set  forth. 

Getting  the  Evidence. — In  meeting  the  necessity  for 
concrete,  objective  evidence,  when  seeking  to  bring  about 
extensions  or  improvements  in  hygiene  activities,  school 
officials  have  received  much  assistance  from  the  local  medical 
and  dental  associations.  In  Philadelphia  Doctor  Samuel  W. 
Newmayer  developed  some  data  showing  the  need  of  the  co- 
operation of  school  nurses  in  medical  school  inspection.  His 
figures^  show  that  in  the  four  schools  where  the  inspector 

>  Reported  in  the  Proceedings  of  the  Fifth  Annual  Congress  of  the  American 
School  Hygiene  Association  under  the  title,  "  Evidence  that  the  School  Nurse 
Pays."  These  results  are  also  printed  in  "Medical  Inspection  of  Schools," 
Gulick  and  Ayres,  pp.  66-67,  revised  edition. 


PUBLIC  CO-OPERATION  89 

was  assisted  by  a  nurse  89  per  cent  of  the  recommendations 
were  acted  upon,  whereas  in  an  equal  number  of  schools  where 
the  medical  inspector  was  unassisted  only  24  per  cent  of  the 
recommendations  were  followed  by  action. 

In  Philadelphia  also  a  very  effective  argument  for  dustless 
cleaning  in  pubHc  schools  was  developed  through  a  tabulation 
by  months  of  contagious  diseases  among  children.  The  ev- 
idence was  graphically  shown  by  means  of  various  columns 
proportioned  to  the  respective  monthly  figures.  The  very 
low  columns  during  the  summer  months,  the  open-window 
period,  and  the  overtowering  columns  of  the  winter  and 
early  spring  months  when  the  windows  are  closed  and  the 
dust-carried  germs  have  undisturbed  sway,  constitute  an  illu- 
minating lesson.  There  are  few  cities  where  it  would  be 
difficult  to  find  some  organization  or  individual  who  would 
assist  a  superintendent  by  delving  into  the  local  vital  statistics 
and  compiling  a  similar  table. 

During  a  mouth  hygiene  campaign  in  Cleveland  directed 
by  national  and  local  dental  associations,  over  20,000  pupils 
were  examined  and  in  97  per  cent  more  or  less  faulty  mouths 
were  found.  Facts  such  as  these  have  a  convincing  power 
and  a  publicity  value  that  is  never  possessed  by  any  single 
man's  convictions  or  opinions,  however  well  stated  or  whatever 
his  reputation. 

A  committee  of  the  Public  Education  Association  of  New 
York  City  recently  employed  a  specialist  to  make  mental 
examinations  in  connection  with  the  work  of  the  ungraded 
classes  in  the  public  schools.  On  the  basis  of  these  examina- 
tions a  reorganization  of  this  department  was  effected. 
Many  other  instances  of  this  form  of  co-operation  could  be 
adduced. 

Publicity  for  the  Facts. — After  developing  the  facts  needed 
to  reinforce  a  request  for  the  introduction  or  extension  of 
medical  inspection,  or  of  any  other  hygiene  activity,  a  great 
deal  of  thought  can  profitably  be  given  to  the  best  way  of 
causing  these  facts  to  reach  the  pubUc.     A  very  common 


go  EDUCATIONAL  HYGIENE 

method  is  by  means  of  the  superintendent's  annual  report. 
A  suggestive  example  is  found  in  the  Northampton,  Massa- 
chusetts, school  report  for  191 2.  The  superintendent  desired 
a  school  nurse,  and  by  way  of  bolstering  his  argument  he 
mentions  some  actual  cases  which  came  to  his  attention 
during  a  single  visit  to  one  school: 

An  intelligent  parent  who  does  not  agree  with  the  head  of  the 
Boston  dispensary  that  two-thirds  of  the  so-called  physical  defects 
of  children  are  caused  directly  or  indirectly  by  decayed  teeth  allows 
a  child  to  be  poisoned  by  decaying  teeth  on  the  theory  that  the  first 
teeth  being  temporary  do  not  need  any  attention;  a  hard-working 
mother  who  does  not  know  what  to  do  to  prevent  scabies  from  spread- 
ing in  her  family  allows  her  children  to  run  wild  and  blames  the  schools 
for  excluding  them;  indulgent  parents  allow  a  nine-year-old  boy  to 
drink  six  cups  of  coffee  a  day,  then  wonder  why  he  fails  to  do  his  work 
at  school  and  is  so  nervous  that  at  times  he  has  no  self-control;  a 
mother  should  have  her  attention  called  to  a  vicious  habit  which  a 
wide-awake  teacher  has  discovered  in  her  eight -year-old  boy;  a  non- 
English-speaking  mother  needs  help  in  freeing  her  children's  heads 
from  parasites,  as  she  cannot  read  the  directions  sent  her  from  the 
school. 

But,  since  in  school  reports  health  matters  must  necessa- 
rily be  mixed  with  many  other  topics,  an  even  better  method 
is  available  when  a  volunteer  agency  makes  the  investiga- 
tion, and  that  is  to  let  it  publish  its  own  report.  Thus  the 
evidence  goes  before  the  public  in  a  conspicuous  manner  and 
under  supposedly  impartial  auspices.  In  the  inquiries  un- 
dertaken by  the  Public  Education  Association,  Bureau  of 
Municipal  Research,  or  the  Woman's  Club  it  is  customary 
to  publish  the  results  in  striking,  individual  reports. 

Exhibiting  the  Facts. — One  of  the  most  effective  instru- 
ments for  developing  public-health  sentiment  employed  in 
recent  years  is  the  child-welfare  exhibit,  and  there  are  many 
instances  where  such  exhibits  have  been  arranged  by  women's 
clubs,  local  bureaus  of  municipal  research,  and  other  associa- 
tions. Detailed  information  upon  exhibit  methods  can  be 
obtained  from  the  Department  of  Surveys  and  Exhibits  of  the 


v^'W 


PUBLIC   CO-OPERATION  9 1 

Russell  Sage  Foundation,  the  National  Child  Welfare  Exhibit 
Committee,  and  the  New  York  Bureau  of  Municipal  Re- 
search. 

Public  Meetings. — In  campaigns  for  open-air  schools  the 
services  of  publicity  experts  can  often  be  secured  from  the 
local  society  for  the  prevention  of  tuberculosis.  Through  long 
experience  with  the  problem  of  awakening  the  public  to  active 
measures  against  the  white  plague,  the  people  connected  with 
this  organization  have  worked  out  very  successful  methods. 
Campaigns  of  considerable  effectiveness  can  also  be  carried 
on  with  the  aid  of  the  local  woman's  club,  chamber  of  com- 
merce, medical  associations,  and  parent-teacher  organiza- 
tions.^ An  instance  of  the  boost  to  school  hygiene  that  is 
accomplished  through  the  occasional  meeting  is  found  in  the 
informal  conference  and  reception  held  under  the  auspices 
of  the  Social  Science  Department  of  the  Peoria  (Illinois) 
Women's  Club  in  honor  of  Miss  Crandall,  of  New  York,  who 
spoke  on  "New  Aspects  of  Visiting  Nurse  Work,"  emphasiz- 
ing the  importance  of  the  public-health  nurse.  To  this  con- 
ference the  department  invited  the  members  of  the  Visiting 
Nurses'  Association,  Registered  Nurses'  Association,  the 
Mothers'  Club,  and  the  Teacher  and  Kindergarten  Clubs. 
Very  often  through  the  social-service  departments  of  the 
local  religious  denominations,  sermons  upon  the  desired  topic 
can  be  secured  in  many  of  the  churches. 

The  Newspapers. — One  of  the  chief  values  of  the  public 
meeting  as  an  instrument  for  developing  public  opinion  is 
the  publicity  which  is  thereby  gained  through  the  news- 
papers. To  meetings  at  which  prominent  persons  are  brought 
together,  both  on  the  platform  and  in  the  audience,  columns 
of  space  will  be  devoted,  which  are  more  valuable  than  paid 
advertisements.  Likewise,  through  the  judicious  appoint- 
ment of  important  persons  on  committees  and  the  reports 
of  meetings  of  committees,   much  helpful  publicity  can  be 

'  See  "Wider  Use  of  the  School  Plant,"  by  Perry,  Chapter  XXI,  "Meetings 
in  School  Houses."     See  also  Chapter  VII. 


92  EDUCATIONAL  HYGIENE 

gained  through  newspaper  accounts.  The  amount  of  space 
devoted  to  meetings  can  generally  be  augmented  by  a  careful 
preparation  for  the  reporters'  needs.  If  copies  of  the  speaker's 
address  and  lists  of  the  committee  memberships,  and  other 
informative  documents,  are  prepared  in  advance  for  the  news- 
paper men,  their  reports  are  usually  not  only  longer  but  also 
much  more  accurate. 

As  indicative  of  the  value  which  newspaper  editors  at- 
tach to  school  items,  it  may  be  mentioned  that  in  191 1  the 
Bureau  of  Municipal  Research^  clipped  from  twenty  news- 
papers over  a  thousand  news  "stories"  and  editorials  on 
school  matters.  Many  superintendents  are  now  taking  ad- 
vantage of  the  opportunities  afforded  by  the  press  in  the  con- 
scious development  of  a  public  sentiment  favorable  to  their 
special  projects.  In  accordance  with  a  well-thought-out  plan 
they  are  systematically  selecting  happenings  in  the  school 
system  in  which  the  public  has  a  legitimate  interest  and  are 
turning  these  items  over  to  the  reporters.  In  some  cities,  when 
the  annual  school  report  is  ready  the  superintendent  hands 
it  out  to  the  newspaper  men  first  and  helps  them  to  find  its 
most  significant  portions.  If  he  has  adopted  a  new  school 
policy  of  broad  import,  he  seeks  a  personal  interview  with  the 
editor  and  endeavors  to  get  the  matter  put  accurately  and  in- 
telligently before  the  public.  If  he  has  completed  an  investi- 
gation which  has  revealed  some  significant  and  important 
facts,  he  turns  his  material  over  to  some  special  writer. ,  If  a 
voluntary  organization  has  rendered  an  important  service^  he 
sees  that  a  definite  account  of  it  reaches  the  news  coluums. 
By  thus  facilitating  the  acquisition  of  school  news  on  the 
part  of  the  press  he  secures  not  only  wide  publicity  for  school 
matters  but  also  a  favorable  attitude  toward  his  work  on  the 
part  of  the  most  influential  organ  of  public  opinion. 

The  Demonstration. — A  method  of  developing  influential 
support  which   seldom   fails  is   that  of   the  demonsti  a  tion. 

>  "Outside  Co-operation  with  the  Public  Schools  of  Greater  New  York,"  by 
the  Bureau  of  Municipal  Research,  p.  12. 


PUBLIC  CO-OPERATION  93 

Medical  inspection  in  the  schools  of  New  York  City  was 
started  in  1897,  but  during  the  first  five  years  there  was  no 
school  nurse.  In  1902  nearly  18,000  children  were  excluded 
from  the  schools,  and  the  classes  were  in  some  cases  so  de- 
pleted that  it  was  difficult  to  carry  on  school  work.  To  meet 
the  serious  situation  thus  created,  the  Henry  Street  Nurses' 
Settlement  offered  the  services  of  a  school  nurse  for  one  month. 
At  the  end  of  that  time  the  results  of  her  work  were  so  ob- 
viously beneficial  that  support  was  immediately  gained  from 
educational  authorities,  the  board  of  health,  and  the  public 
for  the  employment  of  school  nurses.^ 

Similarly,  in  Philadelphia  the  Visiting  Nurses'  Society 
loaned  a  trained  nurse  to  the  city  to  show  the  value  of  this 
adjunct  to  medical  inspection.  Like  demonstrations  have 
also  been  carried  on  in  favor  of  medical  inspection  through 
the  co-operation  of  the  local  associations  of  physicians  and 
dentists. 

Securing  Codes  and  Regulations. — ^The  proper  result  to 
follow  revelations  concerning  insanitary  conditions  is  the 
passage  of  measures  or  the  establishment  of  activities  whereby, 
it  is  hoped,  the  repetition  of  the  evils  discovered  will  be  avoided 
in  the  future.  Thus,  through  the  investigation  by  the  Col- 
legiate Alumnae,  already  referred  to,  Boston  received  a  new 
school  code.  But  the  results  of  an  investigation,  a  survey, 
an  exhibit,  or  a  campaign  of  publicity  will  not  automatically 
translate  themselves  into  new  regulations.  Unless  some  one 
follows  them  up,  the  public  sentiment  they  arouse  will  die 
away  without  concrete  results.  There  are  plenty  of  publi- 
cations which  describe  the  best  forms  of  codes  to  meet  the 
various  exigencies  in  school  hygiene,  but  they  do  not  often 
give  information  as  to  the  best  way  of  manipulating  the 
local  social  forces  through  the  marshalling  and  concentration 
of  which  the  passage  of  the  code  will  be  secured.  Every 
resolution,  ordinance,  code,  or  statute  has  to  receive  the  ap- 
proval of  a  certain  majority,  no  two  members  of  which  have 

^Tbis  first  municipal  school  nurse  has  written  a  chapter  for  this  volume, — Ep, 


94  EDUCATIONAL  HYGIENE 

the  same  view-point,  sympathies,  or  information,  but  each  of 
whom  can  be  moved  by  some  influence  or  other,  and  not  a 
sordid  one  at  that.  The  problem  is  to  find  the  effective  in- 
fluence and  to  bring  it  to.  bear  at  the  right  time  upon  the 
right  person.  With  one  individual  it  will  be  more  evidence 
of  the  actual  physical  need,  and  in  the  case  of  another  evidence 
of  the  public  demand,  or  the  suasion  of  an  influential  friend. 
The  skilful  superintendent  will  make  a  careful  canvass  of 
the  opinions  of  the  members  from  whom  he  is  seeking  legis- 
lation and  tabulate  the  obstacles  which  stand  in  the  way. 
He  will  then  deploy  the  forces  at  his  command  with  a  view  to 
overcoming  them,  in  the  same  careful  way  that  the  general 
plans  a  siege  of  a  city.  Oftentimes  there  is  to  be  found  in 
the  local  civic  or  philanthropic  circles  some  live  secretary 
who  is  also  something  of  a  political  tactician,  whose  services 
can  be  secured  for  assistance  in  this  work.  The  school  board 
of  Minneapolis  called  for  a  commission  of  local  medical  men 
to  advise  with  the  board  on  all  questions  of  school  hygiene. 
This  commission  prepared  a  comprehensive  report  covering 
all  phases  of  the  subject,  and  has  manifested  a  willingness  to 
remain  as  a  permanent  advisory  body.  There  are  few  local- 
ities in  which  similar  co-operation  cannot  be  obtained  from 
public-spirited  physicians,  dentists,  and  oculists. 

Co-operation  in  Administration. — The  British  Board  of 
Education  urges  local  school  authorities  to  secure  the  utmost 
possible  degree  of  co-operation  from  hospitals  and  clinics  in 
their  physical  ministrations  to  pupils;  and  the  same  practise 
is  being  followed  in  many  places  in  the  United  States.  When 
medical  inspection  is  first  inaugurated,  it  often  occurs  that 
sufficient  funds  are  not  provided  to  enable  the  examination 
of  all  pupils  with  adequate  frequency  or  thoroughness,  so 
that  outside  assistance  is  still  greatly  needed.  Frequently  a 
school  nurse  is  not  provided,  or  funds  will  not  allow  the  pur- 
chase of  the  necessary  dispensary  articles.  An  open-window 
schoolroom  may  be  provided  but  no  food  or  the  kind  of 
garments  required  for  fresh-air  work  during  the  cold  months. 


PUBLIC   CO-OPERATION 


95 


These  shortcomings  create  an  opportunity  for  outside  co- 
operation which  is  being  very  generally  utilized  throughout 
the  country. 

From  Medical  Associations. — Prominent  in  this  kind  of 
co-operation  are  the  county  or  local  medical  associations  and 
the  public-health  association.  In  Kenosha,  Wisconsin,  eight 
physicians  connected  with  the  local  medical  association  gave 
their  services  for  three  years  in  the  performance  of  an  an- 
nual medical  inspection  of  school-children.  In  Rochester, 
New  York,  the  Public  Health  Association  furnishes  food  and 
equipment  for  the  open-air  school. 

Physicians. — Sometimes  individual  physicians  take  turns 
in  donating  a  month's  services  to  the  examination  of  school- 
children, or  nose  and  throat  specialists  will  co-operate  in  the 
running  of  a  clinic  for  nose  and  throat  operations.  In  Houston, 
Texas,  the  Association  of  Optics  and  Aurists  co-operated  with 
the  local  school  board  in  the  work  of  medical  inspection.  Many 
instances  of  this  kind  are  revealed  in  the  current  school  re- 
ports. 

Dentists. — The  Harvard  Dental  School  gives  treatment 
to  pupils  at  reduced  rates,  while  the  dental  school  connected 
with  Tufts  College  also  receives  pupils  who  are  sent  to  it  by 
school  nurses.  Dental  cHnics  for  the  benefit  of  school-children 
are  maintained  also  in  the  Louisville  (Kentucky)  College  of 
Dentistry,  the  Homeopathic  Dispensary  at  Orange,  New 
Jersey,  and  the  Memorial  Hospital  at  Pawtucket,  Rhode 
Island.  Doubtless  there  are  many  other  institutions  of  this 
sort  performing  a  similar  service  for  school-children. 

Even  more  common  are  the  instances  of  co-operation 
afforded  by  local  dental  societies.  School  reports  make  fre- 
quent reference  to  the  inspection,  clinical  services,  and  public 
lectures  which  are  given  by  members  of  these  organizations. 
Sometimes  the  services  are  free  and  at  other  times  partly 
paid.  In  some  instances  only  the  inspection  is  made,  while 
in  others  it  is  followed  up  with  a  regular  clinical  service. 
The  Cincinnati  school  report  for  191 2  has  a  very  suggestive 


96  EDUCATIONAL  HYGIENE 

account  of  the  work  performed  by  the  Cincinnati  Dental 
Society.  Its  activities  include  inspection,  maintenance  of 
free  clinic,  lectures  given  school-children,  parents'  clubs  and 
social  settlements,  and  alUed  organizations.  Recently,  in 
connection  with  the  work  of  the  cUnic,  experimentation  has 
been  carried  on  with  a  view  to  showing  the  different  physical 
and  mental  results  obtained  from  a  class  whose  members' 
mouths  were  kept  in  hygienic  condition  and  from  a  class  not 
receiving  systematic  attention.  Again,  individual  dentists 
help  school  authorities  by  inspection,  free  treatment  to  needy 
pupils,  or  even  monetary  contributions  to  help  carry  on  the 
work  of  the  school  clinic. 

Hospitals. — -The  assistance  given  by  hospitals  varies 
more  or  less  in  accordance  with  the  facilities  of  the  institu- 
tion. That  afforded  by  the  Boston  hospitals  is  especially 
notable.  The  Massachusetts  General  Hospital  gives  medical 
and  surgical  attention  to  poor  children  for  a  ten-cent  fee. 
The  same  service  is  also  offered  by  the  out-patient  depart- 
ment of  the  Massachusetts  Homeopathic  Hospital,  while 
the  Children's  Hospital  not  only  furnishes  medical  treatment 
for  pupils  but  arranges  a  course  of  instruction  for  school 
nurses.  At  the  Massachusetts  Charitable  Eye  and  Ear  In- 
firmary treatment  may  be  received  for  a  nominal  fee,  and  in 
addition  eye-glasses  are  supplied  and  investigations  made  of 
the  home  conditions  of  afflicted  children.  The  New  England 
Hospital  for  Women  and  Children  examines  children  before 
they  are  sent  out  on  summer  vacations.  It  also  maintains 
a  dispensary  service  open  to  pupils.  The  Boston  and  the 
Maverick  dispensaries  treat  children  who  are  sent  to  them  by 
the  school  nurses.  In  the  psychopathic  department  of  the 
Massachusetts  State  Hospital  mental  examinations  of  school- 
children are  carried  on.  The  institutions  of  many  other 
cities  are  performing  similar  services  for  school-children. 

Charitable  Societies. — From  the  provident  associations, 
children's  aid  societies,  and  other  charitable  organizations  in 
the  same  class  a  vast  amount  of  co-operation  is  being  received 


'4 

^PJ 

School  dental  clinic  at  Cincinnati,  O.   (i) 


School  dental  clinic  at  Cincinnati,  O.  (2) 

Here  we  see  the  dental  phase  of  the  complete  physical  examination  of  the  pupils  at  the 
Woodward  High  School,  Cincinnati,  O. 


PUBLIC   CO-OPERATION  97 

by  the  schools  in  the  physical  care  of  children.  Eye-glasses 
and  clothing  are  provided,  attention  given  to  special  cases 
reported  by  the  school  nurses,  and  the  home  conditions  in- 
spected and  improved.  Some  organizations  give  attention 
to  the  work  of  facihtating  country  or  seashore  vacations  for 
needy  children. 

The  needs  peculiar  to  crippled  children  are  being  at- 
tended to  by  organizations  estabhshed  for  their  particular 
benefit.  Some  of  these  bodies  afford  transportation,  free 
meals,  or  medical  and  surgical  aid  to  those  in  attendance 
at  the  public  schools.  Others  provide  educational  facihties 
for  those  whose  condition  debars  them  from  the  public  schools, 
and  in  some  instances  trained  nurses  are  sent  to  visit  the 
homes  of  these  unfortunates.  Likewise  the  deaf  and  the  blind 
are  the  recipients  of  the  special  attentions  which  they  require 
from  another  class  of  institution. 

Nursing  Associations. — Another  source  of  most  valuable 
co-operation  is  found  in  the  various  nurses'  associations. 
The  Instructive  Nurses'  Association  of  Boston  provides  home 
attention  for  the  particular  cases  referred  to  it  by  school 
nurses,  while  the  District  Nurses'  Association  of  Scranton, 
Pennsylvania,  supervises  the  instruction  of  school  nurses; 
and  many  other  associations  are  loaning  nurses  to  the  school 
department  or  helping  it  to  demonstrate  the  need  of  this 
most  important  adjunct  to  medical  school  inspection.  The 
co-operation  given  to  the  schools  in  this  field  is  as  miscel- 
laneous as  it  is  important. 

Settlements. — Reference  has  already  been  made  to  the 
nurse  who  was  loaned  to  the  New  York  schools  by  the  Henry 
Street  Nurses'  Settlement.  This  institution  now  maintains, 
under  the  board  of  education,  a  class  for  mental  defectives, 
and  also  facilitates  country  vacations  and  provides  milk  for 
undernourished  children.  Furnishing  school  nurses,  giving 
health  talks  to  parents,  maintaining  open-air  schools,  special 
clinics  for  children  with  uncommon  diseases,  schools  for  sick 
and  shut-in  children,  agitations  for  more  sanitary  buildings, 


98  EDUCATIONAL  HYGIENE 

larger  playgrounds  and  more  apparatus— these  are  only- 
samples  of  the  kinds  of  assistance  which  settlements  through- 
out the  country  are  rendering  school  systems. 

Tuberculosis  Societies. — The  national  and  local  associa- 
tions for  the  prevention  of  tuberculosis,  as  might  be  expected, 
are  giving  valuable  aid  to  the  school  authorities  in  the  estab- 
lishment of  open-air  schools.  The  pioneer  work  of  the  Provi- 
dence (Rhode  Island)  school  committee  in  this  field  was 
stimulated  by  a  suggestion  of  the  local  League  for  the  Sup- 
pression of  Tuberculosis,  and  the  physicians  who  composed 
the  committee  of  this  organization  assisted  in  the  selection 
of  pupils  for  the  school.  In  some  instances  the  local  tuber- 
culosis association  erects  the  building  and  becomes  a  chief 
supporter  of  the  work;  in  others  it  provides  the  coats,  suits, 
and  other  portions  of  the  equipment  or  the  meals.  Some- 
times the  society  provides  lectures  on  hygiene  in  the  various 
schools.  In  addition  to  this  kind  of  service  the  Pawtucket 
(Rhode  Island)  Society  for  the  Prevention  of  Tuberculosis 
presented  forty  dollars'  worth  of  tooth-brushes  and  samples 
of  tooth-paste  to  the  school  nursing  department.  The  Wis- 
consin Anti-Tuberculosis  Association  offered  a  complete  open- 
air  school  equipment  to  the  city  of  that  State  making  the 
highest  per-capita  sale  of  Christmas  seals.  This  equipment 
was  won  by  Kenosha,  as  were  also  the  services  of  a  visiting 
nurse  for  one  month,  furnished  by  the  association. 

Women's  Clubs. — A  vast  amount  of  service  is  being 
given  to  the  promotion  of  child  welfare  by  the  women's  clubs. 
Active  from  the  outset  in  the  playground  propaganda,  they 
are  now  devoting  their  efforts  to  the  establishment  of  school 
lunches  in  high  and  elementary  schools,  arranging  child-wel- 
fare exhibits,  agitating  the  establishment  of  open-air  schools, 
supplementing  the  equipment  of  school  nurses,  and  urging 
the  importance  of  the  best  methods  of  medical  and  sanitary 
school  inspection. 

Parent-Teacher  Associations. — Still  closer  to  the  school 
are  the  parent-teacher  organizations  with  their  varied  activ- 


PUBLIC   CO-OPERATION  99 

Ities  and  services.  Some  are  maintaining  school-lunch  de- 
partments, others  purchasing  playground  apparatus,  or  em- 
ploying home  and  school  visitors,  and  installing  first-aid 
outfits.  The  Fathers'  and  Mothers'  Club  of  Boston  main- 
tains a  farmhouse  for  anemic  children.  These  organizations, 
so  dependent  upon  the  school  for  their  existence,  generally 
consider  opportunities  for  co-operation  in  the  light  of  great 
privileges. 

Oftentimes  the  local  university  is  in  a  position  to  extend 
valuable  co-operation.  The  Department  of  Psychology  of 
the  University  of  Cincinnati  gave  mental  examinations  to 
exceptional  children,  and  the  University  of  Pittsburgh  is 
maintaining  a  similar  service.  The  local  railway  companies 
sometimes  assist  teachers  in  their  instructions  concerning  the 
avoidance  of  accidents  by  furnishing  blotters  teaching  the 
results  of  carelessness  in  boarding  and  departing  from  street- 
cars. A  Safety  League  in  Kenosha,  Wisconsin,  arranged 
lectures  in  the  public  schools  upon  the  various  methods  of 
promoting  safety. 

Individual  Philanthropists. — In  the  conduct  of  the  Chicago 
schools  for  anemic  children  the  board  of  education  supplies 
the  rooms  and  teachers,  while  the  Elizabeth  McCormick  Fund 
provides  the  extra  pay  of  the  physicians  and  nurses  and  meets 
the  expense  attached  to  furnishing  food  and  supplying  extra 
clothing  and  equipment. 

The  Forsyth  Dental  Infirmary  of  Boston,  just  being  opened, 
will  attempt  to  care  for  the  mouth  conditions  of  all  the  chil- 
dren of  Greater  Boston  up  to  sixteen  years  of  age.  The  in- 
stitution was  founded  by  two  brothers  as  a  family  memorial. 
The  benefactors  purchased  the  site,  erected  the  building, 
which  cost  $250,000,  and  have  endowed  the  holding  corpora- 
tion with  a  maintenance  fund  of  about  $1,000,000.  The 
institution  has  facilities  for  sixty-four  chairs,  and  auxiliary 
room  for  forty-four  additional  ones.  It  is  expected  that  it 
will  be  possible  to  treat  over  seven  hundred  cases  daily. 

The  application  of  philanthropic  funds   to   the  field  of 


lOO  EDUCATIONAL  HYGIENE 

school  hygiene  Is,  according  to  the  signs  of  the  times,  likely 
to  show  still  further  extension. 

Assistance  in  Bringing  about  Co-ordination. — This  sort  of 
service  is  illustrated  in  the  work  of  the  Public  Education  As- 
sociation of  the  City  of  New  York.  It  brought  together 
representatives  of  the  departments  of  Health,  Charities, 
Education,  and  the  Children's  Court,  as  well  as  a  number  of 
private  citizens,  in  a  special  committee  devoted  to  the  pro- 
motion of  child  welfare.  The  purpose  of  this  body  was  to 
develop  intelligent  co-operation  between  these  different  de- 
partments, to  define  the  problems  of  school  hygiene,  and  to 
carry  on  intensive  studies  of  some  of  the  more  difficult  ones. 
A  member  of  the  association  staff  was  assigned  to  the  work  of 
this  committee. 

Encouraging  Voluntary  Assistance. — The  Boston  report 
for  1 913  devotes  twenty  pages  of  fine  type  to  a  concise  state- 
ment of  the  one  hundred  and  twelve  organizations  which  are 
co-operating  with  the  public  schools  of  that  city.  Many  of 
the  current  school  reports  are  also  stating  the  needs  of  the 
schools,  which  would  afford  opportunities  for  volunteer  co- 
operation. Thus  by  inviting  co-operation  and  giving  accurate 
credit  for  the  work  that  is  done,  the  welfare  of  school-children 
is  being  more  rapidly  advanced  than  is  possible  through  the 
unaided  activities  of  present  school  systems. 

Educating  the  Home  and  the  Public  in  Health  Practises. 
— In  order  that  the  school's  hygiene  activities  may  find  sup- 
port in  the  pupils'  home  and  neighborhood  environment,  it  is 
necessary  that  much  miscellaneous  health  instruction  be  pro- 
vided for  the  community  which  is  outside  of  the  school- 
building.  And  in  this  work  the  volunteer  associations  also 
are  unusually  helpful.  The  Public  Education  Association  of 
Philadelphia  prepared  and  distributed  through  the  school- 
children ten  thousand  cards  of  health  instructions  to  parents. 
It  also  prepared  and  printed  an  equal  number  of  highly 
effective  pamphlets  on  the  care  of  the  baby  for  distribution 
among  parents.     The   regular  programmes   of   the   various 


PUBLIC  CO-OPERATION  10 1 

parent-teacher  associations  are  full  of  illustrated  lectures 
upon  health  topics.  The  women's  clubs  also  arrange  public 
meetings  which  are  addressed  by  local  physicians,  dentists, 
and  school  inspectors.  The  Social  Welfare  Committee  of 
the  South  Bend  Chamber  of  Commerce  arranges  addresses 
upon  health  subjects  before  social-centre  audiences  in  the 
pubKc  schools;  while  the  Commercial  Club,  of  Louisville, 
Kentucky,  in  one  year  spent  $6,000  on  publicity  work  in 
behalf  of  the  schools.  Such  associations  as  the  Woman's 
Christian  Temperance  Union  and  the  Anti-Cigarette  League 
are  always  ready  to  avail  themselves  of  opportunities  to 
give  public  lectures  upon  their  causes  before  schoolhouse 
audiences.  The  Boston  Milk  and  Baby  Association  not  only 
lectures  upon  its  work  before  pupils  but  conducts  "little 
mothers'"  classes  in  the  high  schools.  In  Chicago  the  Visit- 
ing Nurses'  Association  arranged  a  series  of  lectures^  upon 
intestinal  diseases  in  connection  with  the  vacation  schools, 
to  which  mothers  were  admitted  as  well  as  high  and  gram- 
mar school  pupils.  Many  other  examples  of  volunteer  aid 
in  the  work  of  spreading  the  knowledge  of  health  facts  among 
the  people  in  general  might  be  brought  forward  if  space 
permitted. 

The  instances  which  have  been  set  forth  in  this  chapter 
illustrate  but  do  not  at  all  completely  enumerate  the  various 
ways  in  which  outside  organizations  are  in  many  places  al- 
ready co-operating,  and  in  others  stand  ready  to  co-operate, 
with  the  educational  authorities  in  promoting  a  steady  ad- 
vance in  school  hygiene.  So  freely  and  bountifully,  indeed, 
have  the  voluntary  associations  devoted  means  and  personal 
service  to  human  welfare  that,  in  the  hght  of  their  deeds,  a 
new  meaning  now  seems  to  shine  forth — especially  for  all 
guardians  of  children — from  that  old  scriptural  saying,  once 
rusted  over  with  triteness:  "Ask  and  ye  shall  receive." 

The  following  summarized  suggestions  by  Wm.  H.  Allen, 
in  his  "Woman's  Part  in  Government,"  are  pertinent: 
>  See  "Wider  Use  of  the  School  Plant,"  by  Perry,  p.  142. 


102  EDUCATIONAL  HYGIENE 

The  following  first  steps  are  suggested  to  local  schools  wishing 
to  increase  their  power  for  civic  education: 

1.  Ask  for  a  State  law  on  medical  examination  of  all  children, 
teachers,  janitors,  buildings,  and  grounds  in  all  school  districts,  public, 
parochial,  private,  rural,  and  urban. 

2.  Teach  personal  hygiene  by  relating  it  to  community  hygiene. 

3.  Keep  your  communities  continuously  informed  in  regard  to 
health  needs  indexed  at  school. 

4.  Realize  that  every  parent  interested  adds  a  teacher  to  your  staff. 

5.  Give  your  neivs papers  school  stories  and  thus  add  25  per  cent 
to  the  efficiency  of  your  teaching  staff. 

6.  Make  private  agencies  supplement  school  work,  instead  of  sup- 
plementing their  work. 

7.  Make  your  schools  the  centre  of  social-settlement  work  and  up- 
lift work  in  your  communities. 

8.  Recognize  that  it  is  just  as  educational  to  interest  the  board  of 
education  and  the  voluntary  visiting  committee  as  to  instruct  a  child. 

9.  Provide  for  civic  and  health  work  by  your  school  organizations. 

10.  Take  advantage  of  budget  season  to  tell  100  per  cent  of  school 
and  health  needs  and  to  interest  100  per  cent  of  your  community  in 
that  story. 

11.  Welcome  complaints  and  questions  as  opportunities  for  civic 
education. 

12.  Make  more  demands  upon  your  State  department  of  education 
and  give  it  better  support. 

13.  Write  your  congressmen  and  senators  to  give  the  United 
States  Bureau  of  Education  enough  work  and  enough  money. 

14.  Co-operate  with  the  National  Education  Association's  special 
committee  on  uniform  and  adequate  records  and  reports. 


CHAPTER  VI 
THE  SOCIAL  CENTRE  AND  EDUCATIONAL  HYGIENE 

The  Situation. — Sisyphus  had  to  keep  on  rolling  at  the 
stone,  even  though  he  could  not  succeed.  He  had  to  keep  on, 
or  otherwise  it  would  have  rolled  back  and  crushed  him. 
And  just  so  we  must  keep  on  spending  our  force  in  and  through 
the  public-school  system  as  it  is  to-day  in  pressing  back  the 
forces  of  disease  and  death  in  the  programme  of  educational 
hygiene.  We  cannot  stop  using  the  means  we  have,  for  we, 
too,  are  laboring  for  our  lives. 

But,  away  back  when  first  I  heard  of  Sisyphus,  I  wondered 
why  he  did  not  hold  the  stone  with  one  hand  and  shoulder 
and  with  the  other  hand  or  with  his  foot  place  a  cobble  under 
it,  or  somehow  reach  around  and  rig  a  block  and  tackle  at 
the  back  of  the  stone  by  which  his  labor  might  be  accom- 
plished. Had  he  been  able  to  do  that,  he  would  not  only 
have  succeeded  in  his  undertaking,  but  he  would,  so  far, 
have  spoiled  and  transformed  Hades.  The  social-centre  move- 
ment, the  full  use  of  the  common-school  system  as  the  ma- 
chinery of  adult  and  older-youth  civic,  industrial,  recreational 
organization  and  co-operation,  is  the  rigging  of  the  block  and 
tackle  around  behind  the  stone — the  means  by  which  the 
otherwise  futile  and  discouraging  enterprise  of  radically  pro- 
moting public  health  through  the  agency  of  the  public-school 
system  shall  become  an  achieving  enterprise,  whose  process 
will  go  far  toward  transforming  our  inferno. 

Our  experience  in  trying  to  make  of  the  common-school 
system  as  it  is — used  one-third  of  the  time,  by  only  the  one- 
third  of  us  who  are  children,  for  the  mere  one-third  of  the 
educational  process,  which  consists  of  children's  instruction 

103 


I04  EDUCATIONAL  HYGIENE 

• — an  effective  and  dynamic  agency  for  the  promotion  of  chil- 
dren's health,  seems  to  necessitate  this  statement: 

The  common-school  system,  as  at  present  manned  (or 
rather  womaned),  as  at  present  housed  (or  rather  barned), 
as  at  present  stunted,  fails,  and  is  likely  to  keep  on  failing,  to 
be  greatly,  radically  promotive  of  even  the  children's  health. 

On  the  other  hand,  the  experiments  in  social-centre  de- 
velopment, even  the  little  timid  experiments  that  have  been 
made  thus  far,  justify  this  statement: 

When  the  characteristic  community-building-and-yard 
equipment  of  America  has  ceased  to  be  merely  the  children's 
school  system,  and  has  come  to  be  really  the  public-school 
system,  in  use  as  well  as  in  ownership,  it  will  be  the  adequate 
machinery  of  public-health  advance  and  so  will  make  the 
health  service  of  the  children  efficient. 

Two  Factors. — There  are  two  necessary  things  to  be  done 
in  order  to  make  the  public-school  system  an  effective  agency 
for  health  promotion.  In  the  first  place,  the  school  must  be 
radically  improved  in  the  character  of  its  educational  staff, 
in  the  character  of  its  physical  equipment,  and  in  its  curric- 
ulum. In  the  second  place,  the  problem  of  sociological  ad- 
justment, political,  industrial,  and  recreational,  must  be  dealt 
with. 

To-day  the  profession  of  the  public-school  man  or  woman 
is  a  third-rate  profession.  The  salary  standard  is  third-rate, 
and,  in  general,  the  professional  calibre  of  the  men  and  women 
employed  in  public-school  service  is  one-third  of  what  it 
should  be.  What  is  true  of  the  personnel  of  the  public- 
school  service  is  in  general  true  of  the  housing,  grounding, 
and  equipment  of  this  characteristic  American  institution. 
And,  judged  by  a  standard  of  vital  practical,  economical, 
and  constructive  arrangement  of  physical  and  mental  activ- 
ity of  children  in  the  public  schools,  the  curriculum  is  not 
more  than  a  third  as  good  as  it  should  be. 

What  is  the  answer?  "More  money  for  the  public  schools," 
says  President  Eliot.    Yes,  but  how  are  we  going  to  get  it? 


SOCIAL  CENTRE   AND   EDUCATIONAL   HYGIENE        105 

There  are  other  needs  for  the  improvement  of  the  public 
schools  to  the  point  where  they  will  be  efficient  agencies  in 
the  promotion  of  health,  other  needs  than  money.  How  are 
these  to  be  satisfied? 

The  longest  way  round  is  often  the  shortest  way  home, 
and  the  problem  of  making  the  public  school  an  efficient 
agency  for  health  promotion  is  to  be  solved  most  directly  by 
coming  at  it  indirectly. 

Political  Beginning. — The  beginning  of  social-centre  devel- 
opment is  poUtical.  Whether  our  objective  be  citizenship-train- 
ing improvement,  moral-training  improvement,  industrial- 
training  improvement,  or  health-promoting  improvement  in 
the  efficiency  of  the  public  schools,  the  first  step  is  the  same. 
It  is  the  shifting  of  the  voting  apparatus  into  the  public 
schoolhouse.  It  is  the  use  of  the  pubUc  schoolhouse  as  the 
polling-place  of  its  district. 

The  reason  for  this  is  not  chiefly  its  economy,  great  as 
that  is;  it  is  because  the  estabUshment  of  the  voting  head- 
quarters in  the  school  building  makes  of  this  building  in  actual 
practise  a  public  place  of  assembly  and  organization.  The 
"pubHc"  school  as  a  juvenile  instructional  institution  is  not 
now,  in  practise,  a  common  place  of  public  assembling  even 
as  the  pubUc  is  represented  in  the  children.  There  are  paro- 
chial schools.  But  there  is  no  parochial  ballot-box.  And 
when  the  ballot-box  is  established  in  the  schoolhouse,  the  fact 
is  declared  and  realized  that  this  is  a  common  building,  a 
centre  of  public  organization  and  expression. 

See  some  of  the  immediate  practical  results  of  using  the 
schoolhouse  as  the  polling-place,  results  having  to  do  with  the 
improvement  of  this  institution  on  fines  of  public-health 
service. 

Voting  in  the  schoolhouse  impfies  making  the  school  prin- 
cipal the  voting  clerk  of  the  district.  He  or  she  is  at  once 
brought  into  official  direct  contact  with  the  adults  of  the 
community.  This  added  function  impfies  some  increase  in 
salary  and'  increase  in  dignity  and  influence.    The  building  is 


Io6  EDUCATIONAL  HYGIENE 

soiled  by  its  use  for  voting,  and  the  splendid  Emersonian 
principle  that  "things  are  good  if  they  are  only  bad  enough" 
is,  as  Health  Officer  George  W.  Goler,  of  Rochester,  has  said, 
brought  into  play.  The  building  was  dirty  as  a  result  of  the 
children's  use,  but  it  wasn't  dirty  enough  to  necessitate  thor- 
ough cleaning  and  renovating.  Its  use  as  a  polling-place 
points  this  necessity,  and  the  result  is  that  the  building  is 
cleaned.  The  citizens  of  the  district  coming  to  the  school- 
house  see  its  architectural  ugliness  and  its  poverty  of  equip- 
ment; and  its  use  as  a  polling-place,  the  real  headquarters 
of  government  in  a  democracy,  tends  to  its  improved  archi- 
tecture. The  vitalizing  influence  of  this  use  of  the  school 
building  for  the  primary  expression  of  citizenship  upon  the 
civic  training  of  the  children  is  obvious  and  fundamental  in 
its  importance. 

Deliberative  Associations. — The  next  step  in  social-centre 
development  is  the  organization  of  the  citizens  of  each  dis- 
trict whose  names  are  recorded  upon  the  voting  register  at 
the  polling-place,  now  established  in  the  schoolhouse,  into  a 
deliberative  association  to  use  the  school  building  as  the  dis- 
trict common-council  chamber,  the  headquarters  of  presenta- 
tion and  discussion  of  public  questions.  This  implies  the 
service  of  the  school  principal  or  of  an  associate  as  the  dis- 
trict clerk  or  secretary  of  the  citizenship  in  its  assembling  for 
discussion.  The  school  man,  hitherto  a  man  among  women 
and  children,  becomes  a  man  among  men;  the  agent  of  the 
citizenship  in  the  instruction  of  the  children  comes  to  be  forti- 
fied in  his  influence  by  his  relationship  of  direct  service  under 
the  citizenship  as  the  civic  secretary.  And  a  more  present- 
minded,  capable  man  or  woman  is  made  necessary  for  this 
position.  The  schoolhouse  becomes  the  place  of  frequent 
assembling  of  the  adults  of  the  neighborhood.  As  such  its 
architectural  character  and  its  physical  equipment  depend  not 
only  upon  the  generosity  but  upon  the  self-interest  of  the 
citizens.  The  organizing  of  contemporary  public  problems 
into  a  curriculum  of  self-education  through  discussion  by  the 


SOCIAL  CENTRE   AND   EDUCATIONAL  HYGIENE        107 

citizens,  sets  a  vitalizing  standard  of  government-in-action 
to  which  the  civic  training  of  the  children  becomes  a  real  ap- 
prenticeship. 

Self-Govemment  Clubs. — Then  comes  the  organization 
of  the  boys  of  the  community,  the  boys  between  school  age 
and  majority,  into  a  self-governing  club,  modelled  upon,  or 
rather  patterned  after,  the  adult  civic  organization.  This 
implies  the  companionship  of  a  club  director,  which  work  be- 
comes a  function  of  the  school  principal  or  of  a  member  of 
his  staff.  It  implies  the  interest  of  another  great  section  of 
the  community,  the  youth,  who  may  be  counted  upon  always 
to  favor  improvement — their  interest  and  ambition  for  better 
architecture  and  equipment.  And  the  connection  between 
the  children  and  the  adults,  the  connection  between  appren- 
ticeship and  the  actual  practise  of  citizenship,  is  made  and 
strongly  made  for  the  children  by  setting  before  them,  in 
the  practise  of  the  older  boys,  training  in  self-government. 

What  is  true  of  this  provision  of  the  schoolhouse  as  the 
assembling-place  of  the  boys  who  are  above  school  age  but 
have  not  yet  reached  twenty-one,  as  to  its  need  and  value, 
is  true  of  its  use  as  the  meeting-place  of  the  neighborhood 
club  of  girls  between  school  age  and  adulthood. 

Incidentally,  this  use  of  the  schoolhouse  as  the  club-house 
for  the  older  boys  and  for  the  older  girls  of  the  district  pro- 
vides the  machinery  and  the  opportunity  for  their  instruc- 
tion in  matters  appropriate  to  their  age,  matters  particularly 
of  pubhc  liealth  and  personal  hygiene. 

Weekly  Meetings. — Next  comes  the  use  of  the  schoolhouse 
as  the  weekly  gathering-place  for  general  neighborhood  as- 
sembling. With  one  evening  in  the  week  devoted  to  the 
gathering  of  citizens  for  presentation  and  discussion  of  public 
questions,  one  evening  centred  upon  the  boys'  club  meeting, 
one  evening  given  up  to  the  girls'  club  meeting,  and  along 
with  these  an  evening  when  old  and  young  gather  for  a 
programme  which  begins  with  the  orchestral  music  provided 
bv  the  neighborhood  orchestra  that  is  bound   to  get  itself 


I08  EDUCATIONAL  HYGIENE 

formed  to  meet  this  need,  and  then  a  half-hour  of  communal 
singing  and  then  a  lecture  or  entertainment  or  motion-picture 
exhibition,  closing  with  an  hour's  dancing  of  young  people 
and  older  people  together,  with  ideal,  homelike  chaperonage, 
the  basic  organization  for  social-centre  development  is  com- 
pleted. 

Obviously  for  the  arrangement  and  promotion  of  such 
general  neighborhood  evenings  the  service  of  a  member  of 
the  school  staff,  whether  the  school  principal  or  an  associate, 
is  necessary,  and  obviously  the  inclusion  of  this  function  in 
the  office  of  school  man  or  school  woman  means  the  socializ- 
ing and  warming  and  elevating  of  that  office.  Obviously, 
also,  it  tends  powerfully  toward  the  improvement  of  the 
architecture  and  equipment  of  the  building,  for  this  improve- 
ment becomes  a  matter  of  citizenship  self-interest  instead  of 
depending  merely  upon  generosity.  And  plainly  this  use  of 
the  schoolhouse  as  a  centre  of  neighborhood  assembling  and 
attraction  will  tend  to  influence,  to  vitalize,  and  humanize 
the  curriculum  of  the  children's  instruction  there. 

The  Social  Centre  as  a  Health  Agency. — The  machinery 
is  now  established  for  attacking  the  problem  of  public  health 
and  all  other  public  problems  after  a  constructive  and  demo- 
cratic fashion. 

In  the  forum  of  the  citizens,  the  imperative  need  of  pro- 
viding physical-training  opportunities  for  the  community  is 
set  forth.  The  outcome  is  almost  sure  to  be  the  equipping 
of  the  schoolhouse  and  the  school-grounds  with  gymnasia 
indoors  and  out,  and  with  bathing  facilities. 

If  medical,  dental,  and  optical  service  has  not  already 
begun  in  the  school,  the  matter  of  its  introduction  becomes 
a  natural  next-thing-to-do,  for  the  use  of  the  schoolhouse  as 
the  local  health  office  makes  a  twofold  appeal.  On  the  one 
hand,  those  who  are  interested  particularly  in  the  public- 
health  movement  see  the  opportunity  that  is  offered  to  get 
at  the  whole  community  through  having  health  service  and 
health  instruction  centred  there;    and,  on  the  other  hand, 


SOCIAL  CENTRE   AND   EDUCATIONAL  HYGIENE        IO9 

the  opportunity  of  co-operatively  providing  for  the  com- 
munity's health  makes  its  appeal  not  only  to  the  parental 
interest  but  to  the  selfishness  of  the  citizens. 

And  not  only  is  the  machinery  provided  for  redeeming  the 
medical  and  pharmaceutical  profession  of  the  country  by 
identifying  the  physician's  service  with  education,  and  so 
realizing  the  true  meaning  of  "doctor"  (which  is  not  pill- 
counter,  nor  coddler,  nor  bill-collection  worrier,  but  teacher); 
but  the  machinery  is  provided  for  attacking  the  roots  of  in- 
dividual and  social  disease  in  political  corruption,  economic 
maladjustment,  and  leisure-time  exploitation — and  so  ade- 
quately and  efifectively  dealing  with  the  problem  of  public 
health.i 

"The  Heart  of  It."— Of  the  effective  pioneers  of  the 
public  health  movement,  the  one  whose  memory  is  most  re- 
vered in  Wisconsin  is  Frank  Avery  Hutchins,  founder  and 
first  secretary  of  the  Wisconsin  Anti-Tuberculosis  Associa- 
tion, founder  and  first  secretary  of  the  State  Free  Library 
Commission,  organizer  and,  until  his  death,  secretary  of  the 
Department  of  Public  Discussion  in  the  University  Exten- 
sion Division.  The  last  words  of  this  clear-eyed  construct- 
ing engineer  of  Wisconsin's  machinery  for  social  and  indi- 
vidual self-enlightenment  were  spoken  in  response  to  the 
news,  brought  to  his  bedside,  of  the  estabHshment  of  the 
schoolhouse  as  the  polling  place  and  community  centre,  and 
the  appointment  of  the  school  principal  as  community  sec- 
retary, in  one  of  the  small  towns  of  the  State.  His  words, 
whispered  with  the  utmost  difhculty,  but  with  a  note  of 
profound  gladness,  were:  "That  goes  to  the  heart  of  it."  To 
him  "it"  meant  the  tremendous  problem  of  making  the 
public  whole — which  is  the  problem  of  public  health. 
»See  Ward's  "The  Social  Center"  (Appleton). 


PART  II 

THE  ADMINISTRATION  OF  EDUCATIONAL 

HYGIENE 

CHAPTER  VII 

THE    INITIATION    OF    A    SYSTEM    OF    EDUCATIONAL 
HYGIENE   IN   A   SCHOOL   SYSTEM 

Including  a  School-Health  Survey 

Public  Opinion  Basis  for  Public-School  Progress. — All  the 

principles  of  pedagogy,  social  psychology,  and  poHtics,  in  the 
best  sense,  figure  in  the  initiation  of  any  or  all  of  the  phases 
of  educational  hygiene  in  a  school  system.  The  prejudices, 
enthusiasms,  and  social  peculiarities  of  the  community,  or 
state,  must  be  taken  into  thoughtful  consideration.  The 
superintendent  must  study  the  people  he  is  to  bring  up  to  a 
higher  standard  of  personal  and  pubHc  hygiene,  at  least  as 
carefully  as  the  teacher  must  study  the  children  she  is  to 
educate.  PubHc  opinion  is  not  a  thing  to  scorn  or  to  disre- 
gard, and  it  is  likewise  not  a  thing  impossible  to  build  up, 
guide,  and  make  effective  in  the  promotion  of  the  pubHc 
good.  We  must  not  thrust  educational  innovations  upon 
people  without  first  helping  them  to  feel  the  need  of  them. 
It  is  far  better  that  through  skilful  indirect  guidance  they 
may  be  led  to  demand  and  to  work  for  needed  improvements 
than  that  they  get  them  by  imperial  fiat  from  the  superin- 
tendent's office  or  mayor's  chair.  Here  is  where  probably 
most  superintendents  fail  and  where  all  real  leaders  of  the 
people  succeed.  The  latter  know  how  to  create  and  to  guide 
the  specific  form  of  desirable  pubHc  opinion,  thus  promoting 


INITIATING   EDUCATIONAL  HYGIENE  III 

the  self-acti\dty  of  the  community,  while  the  latter  work  at 
the  school  as  if  the  school  system  were  in  a  world  of  its  own 
and  the  only  function  of  the  community  were  to  furnish  the 
children  and  the  money,  especially  the  latter. 

David  Starr  Jordan  says  somewhere  that  years  ago  in 
southern  Indiana  he  came  upon  the  track  of  a  man's  influ- 
ence on  a  community  that  was  as  clear  and  as  unmistakable 
as  the  footprint  of  a  mastodon  in  the  fossil-bearing  rock. 
This  man  had  long  since  passed  on,  but  he  had  Hfted  the 
community  to  higher  levels  and  standards,  and  had  given  to 
it  an  ineffaceable  impress.  This  man  probably  knew  very 
well  in  a  practical  way  plain  folk  psychology,  the  methods 
of  rousing  pubHc  sentiment,  of  developing  this  into  specific 
public  opinion,  and  of  guiding  this  onward  to  public  demand 
and  pubHc  action,  including  all  the  factors  of  local  leader- 
ship and  availabih'ty  of  special  groups.  Some  one  should 
collect  from  the  experience  of  thousands  of  teachers  and 
superintendents,  as  well  as  from  the  various  men  and  agen- 
cies that  have  been  successful  or  unsuccessful  in  the  moulding 
of  pubUc  opinion,  the  data  which  when  sifted  would  put  into 
the  hands  of  school  people  a  set  of  principles,  richly  illus- 
trated, setting  forth  the  guiding  lines  for  success  in  this  field. 
Its  relative  worth  in  school-administration  courses  would  be 
very  high.  We  wish  here  to  outline  on  an  empirical  basis 
a  plan  for  taking  the  steps  toward  school-health  progress. 

Steps  Toward  School-Health  Progress 

(i)  Getting  Informed. — The  superintendent  should  in- 
form himself  thoroughly  on  the  principles  of  the  work  and  on 
what  other  communities  are  doing.  For  this  he  will  need 
some  of  the  best  books  and  pamphlets  and  a  number  of  school- 
health  reports,  giving  particular  attention  to  cities  or  regions 
about  the  same  size  or  smaller  than  his  own.  From  a  pam- 
phlet published  by  the  Sage  Foundation  he  can  learn  of  the 
cities  and  towns  with  populations  near  his  own  in  size  that 


112  EDUCATIONAL  HYGIENE 

are  doing  superior  work  in  this  field.  The  reports  of  the 
national  boards  of  education  of  England  (Whitehall,  Lon- 
don) and  Scotland  (Edinburgh)  are  always  valuable  and 
suggestive,  and  many  cities  and  rural  regions  that  are  doing 
able  health  work  can  be  located  by  their  use,  and  the  local 
reports,  say  of  Bradford,  Cambridge,  or  Dunfermline,  may  be 
obtained. 

(2)  Interesting  the  Teachers. — Next  get  the  teachers  with 
you  by  principals'  and  teachers'  meetings,  if  your  system  is 
so  large.  Rural  teachers  in  non-consolidated  schools  will 
start  directly  with  the  children  and  people  of  the  community, 
as  described  in  Carney's  "Country  Life  and  the  Country 
School."  Teachers  may  be  led  to  procure  good  school- 
health  handbooks  to  use  in  reading-circle  meetings  at  the 
buildings.  There  may  be  talks  by  principals,  supervisors, 
superintendents,  doctors,  nurses,  or  other  specialists.  Further 
steps  in  disclosing  the  local  health  situation  in  each  teacher's 
room  will  readily  bring,  in  most  cases,  enthusiastic  response. 

(3)  Using  the  Newspapers. — About  this  time  newspaper 
work  may  well  begin,  if  not  earlier.  The  superintendent  should 
see  the  editors  and  talk  over  the  health  needs  of  the  schools 
and  the  thing  he  is  trying  to  accomplish.  By  interviews, 
articles,  quotations  from  papers,  magazines,  and  books,  by 
pictures  of  conditions  both  from  other  places  and  the  local- 
ity, by  stories  of  the  findings  of  the  doctors  and  nurses  when 
they  begin  their  work  or  the  findings  of  the  teachers  when 
they  make  their  preliminary  surveys,  much  interesting  ma- 
terial may  be  used  to  get  the  people  to  thinking  along  school- 
health  lines  and  to  see  to  what  desirable  standards  their  own 
community  should  advance.  If  superintendents  and  editors 
were  as  skilful  as  certain  advertisers  of  chewing-gums  and 
safety  razors,  not  to  mention  other  enterprises,  the  health 
movement  in  our  country  would  be  vastly  accelerated. 

(4)  School-Health  Survey  by  School  Officials. — When 
the  teachers  realize  the  importance  of  more  attention  to  the 
health  problem  of  the  schools  and  community,  it  is  time  to 
show  them  how  to  do  something.     Doctor  Hoag  says  in  a 


INITIATING    EDUCATIONAL   HYGIENE"  II3 

bulletin  of  the  United  States  Bureau  of  Education  (555)  that 
teachers  can  without  much  previous  training,  but  with  the 
help  of  certain  detailed  directions,  diagnose  or  discover  90 
per  cent  of  the  ailments  of  school-children.  The  Ohio  School 
Survey  shows  that  there  are  a  few  limitations  to  this  gen- 
eralization, but  that  teachers  can  pick  out  most  of  the  flagrant 
cases  is  well  demonstrated.  I  would  advise  here,  then,  a 
school-health  survey,  or  census,  made  by  teachers,  principals, 
and  superintendents,  with  perhaps  some  voluntary  outside 
assistance.  This  survey  should  include:  Medical  Super\'ision, 
School  Sanitation,  Physical  Education,  and  the  Teaching  of 
Hygiene,  and  perhaps  the  Hygiene  of  Methods,  or  Instruc- 
tion.^ 

(a)  Medical  Supervision. — Use  here  Doctor  Hoag's  form 
for  this  purpose  as  given  below  and  published  in  the  bulletin 
(555)  above  mentioned,  and  printed  separately^  as  an  in- 
expensive folder  for  the  use  of  schools.  The  bulletin  men- 
tioned may  be  had  from  the  superintendent  of  documents, 
Government  Printing  Offtce,  Washington,  D.  C.  Doctor 
Hoag's  Diagnostic  Chart  for  teachers,  given  in  his  "Health 
Index  of  Children"  and  in  "Health  Work  in  the  Schools," 
is  also  valuable  for  daily  use  after  the  survey  is  over.  Snellen 
test  charts  may  be  used  for  vision  tests,  and  principals  or 
superintendents  may  even  use  the  Binet-Simon  tests  for  in- 
telligence for  a  few  selected  pupils.  When  each  child  has 
been  studied  by  teachers  and  principals  from  the  health 
standpoint  in  this  way,  the  results  as  summarized  may  well 
be  published.  Voluntary  physicians,  dentists,  oculists,  psy- 
chologists, and  neurologists  may  be  called  in  to  verify  any 
unusual  or  serious  findings.  The  parents  of  children  found 
defective  should  be  notified  and  requested  to  go  to  their 
family  physician,  specialist,  or  dispensary,  to  have  the  teachers' 
findings  checked  up,  and  the  ailments,  if  any,  treated  and 
cured.     It  is  well  to  be  cautious  and  conservative  here,  in 

'Doctor  Wood's  pamphlet   on   "Health  and   Education"   (University  of 
Chicago  Press)  will  be  found  very  suggestive  for  each  of  these  five  divisions. 
*  By  Whitaker  and  Ray-Wiggin  Co.,  San  Francisco,  Cal. 


114  EDUCATIONAL  HYGIENE 

order  that  real  ailments  and  defects  may  be  reported,  so  the 
confidence  of  the  parents  may  be  built  up,  not  shattered. 
If  the  voluntary  work  by  specialists,  as  above  suggested, 
may  be  brought  in  to  confirm  and  to  modify  the  teachers' 
reports,  it  will  be  still  better.  Doctor  Hoag's  form  is  here 
inserted : 

AN  OUTLINE  FOR  THE  HEALTH   GRADING 

OF 

THE  SCHOOL-CHILD  1 

BY 

Dr.  Ernest  Bryant  Hoag 

child-study  specialist,  los  angeles,  cal.,  formerly  special  di- 
rector of  school  hygiene,  minnesota  state  board  of  health 


School Date . . 

Pupil's  name Grade . 

Teacher's  name 

Town  or  city 


HEALTH  GRADING  OF  THE  SCHOOL-CHILD 

(For  Teachers  or  School  Nurses) 

Directions  for  Use 

This  plan  for  the  health  grading  of  school-children  consists  of 
two  parts: 

1.  An  outline  for  a  partial  health  survey  to  be  made  with  the 
aid  of  the  pupils  themselves,  or,  in  the  case  of  young  pupils,  with  the 
aid  of  parents. 

2.  An  outline  for  a  more  extensive  health  survey  on  the  part  of 
teachers. 

In  schools  where  a  medical  officer  or  nurse  is  employed  this  out- 
line will  serve  as  a  useful  preliminary  health  survey. 

With  the  employment  of  this  survey  no  school  need  wait  for  the 
appointment  of  a  medical  officer  or  nurse  before  commencing  some 
effective  health  work  with  school-children. 

It  is  desirable  that  the  teacher  should,  in  the  absence  of  medical 
officer  or  nurse,  make  this  survey  as  early  as  possible  after  the  chil- 
dren enter  school,  but  if  necessary  the  teacher  may  take  her  own 

*  A  four-leaf  folder  for  ea  h  child. 


INITIATING   EDUCATIONAL  HYGIENE  I15 

time  and  complete  the  survey  of  the  children  in  her  room  at  her  own 
convenience. 

It  is  desirable  that  this  survey  be  made  in  the  case  of  every  child, 
but  in  any  event  the  teacher  should  make  it  in  the  case  of  every 
pupil  whom  she  suspects  of  being  mentally  or  physically  unsound. 

The  answers  obtained  to  any  one  question  may  be  of  no  particular 
significance,  biit  tlie  answers  taken  as  a  whole  will  be  of  very  great 
significance.  The  answers  to  questions  in  the  same  group  are  often 
of  great  importance.  For  example,  it  may  be  discovered  that  a  pupil 
complains  of  headache,  blurred  vision,  and  inability  to  see  easily  what 
is  written  on  the  board.  In  such  a  case  the  pupil  is  unquestionably 
suffering  from  a  more  or  less  serious  eye  defect.  Or,  again,  it  may  be 
noted  that  the  pupil  complains  of  earache,  running  ear,  and  perhaps 
inability  to  hear  easUy  what  the  teacher  says.  Such  a  group  of  sig- 
nificant points  would  indicate  unquestionable  ear  disease  leading  to 
permanent  deafness.  A  peculiar  standing  posture  may  indicate  any 
one  of  a  number  of  things,  for  example,  spinal  disease,  weak  muscles, 
beginning  hip-joint  disease,  etc. 

The  teacher  is  strongly  recommended  to  make  these  surveys  with- 
out attracting  the  attention  of  the  individual  pupil  too  much  to  the 
fact  that  he  is  under  observation.  The  teacher  will  soon  discover  that 
her  powers  of  observation  in  matters  pertaining  to  the  pupils'  health 
will  be  greatly  increased  and  her  attention  will  be  called  to  many 
things  of  importance  which  she  formerly  entirely  overlooked.  As  a 
matter  of  fact,  one  of  the  most  important  uses  of  this  health  survey 
consists  in  the  fact  that  it  trains  the  teacher's  powers  of  observation. 

When  one  or  more  conditions  are  discovered  by  the  use  of  this 
survey,  which  in  the  opinion  of  the  teacher  require  attention  from 
the  family  physician,  specialist,  or  dentist,  a  notice  should  be  sent 
to  the  parents  in  the  following  form: 

Date 

Notice  to  Parents  or  Guardians: 

appears  to  the  teacher  to  be  in  need  of 

attention.     A  further  examination  by 

your  family  physician,  dentist,  or  specialist,  is  advised. 

Principal. 

School. 

The  parent  will  please  sign  here  and  return  the  notice  to  the 
principal. 


Il6  EDUCATIONAL  HYGIENE 

HEALTH  SURVEY 

Part  I 

(Questions  to  be  answered  by  Pupil  or  Parent) 

Name School 

Date Grade 


Question  i.  How  old  are  you? 

Answer:  

Question  2.  Have  you  ever  had  much  sickness?  Yes  No 

Answer:  

Question  3.  Are  you  well  now? 

Answer:  

Question  4.  Do  you  eat  breakfast  every  day? 

Answer:  

Question  5.  Do  you  eat  dinner  every  day? 

Answer:  

Question  6.  Do  you  drink  coffee  ? 

Answer:  

Question  7.  Do  you  drink  tea? 

Answer:  

Question  8.  Do  you  have  your  bedroom  window  open  or  shut  at 
night  ? 

Answer:  

Question  9.  Have  you  ever  been  to  a  dentist? 

Answer:  

Question  10.  Do  you  own  a  tooth-brush? 

Answer:  

Question  11.  Do  you  use  a  tooth-brush? 

Answer :  

Question  12.  Do  you  have  headache  often? 

Answer:  

Question  13.  Can  you  read  easily  what  is  written  on  the  blackboard? 

Answer:  

Question  14.  Does  the  print  blur  in  your  book? 

Answer:  

Question  15.  Do  your  eyes  trouble  you  in  any  way? 

Answer:  

Question  16.  Do  you  often  have  earache? 

Answer:  

Question  17.  Do  your  ears  ever  run? 

Answer: 


INITIATING   EDUCATIONAL  HYGIENE  II7 

Question  18.  Can  you  hear  easily  what  the  teacher  says? 

Answer :  

Question  19.  Is  it  hard  for  you  to  breathe  through  your  nose? 

Answer:  

Question  20.  Do  you  have  sore  throat  often? 

Answer :  

Question  21.  Do  you  tire  easily  in  school? 

Answer:  

Question  22.  Do  you  work  any  out  of  school  hours? 

Answer: 

Question  23.  What  kind  of  work? 

Answer: 

Question  24.  How  much  ? 

Answer:  , 


I. 

2. 
3- 
4- 

I. 

8. 


HEALTH  SURVEY 

Part  II 

(Questions  to  be  answered  by  the  Teacher)  * 

A.     General  Appearance 

Is  the  child  healthy-appearing? 

Is  his  color  good  ? 

Is  he  physically  well  developed  ? 

Is  he  free  from  apparent  deformities? 

Has  he  a  good  standing  posture  ? 

Has  he  a  good  sitting  posture  ? 

Are  the  shoulders  even  ? 

Does  the  child  walk  normally? 

Are  the  heels  of  the  shoes  worn  evenly? 

Is  the  physiological  age  of  the  child  apparently 
equal  to  his  actual  age  ? 


B.    Mental  Conditions 

Is  the  child  normally  advanced  in  school  ? 

Is  he  mentally  alert  ? 

Does  he  answer  ordinary  questions  intelligently?. 
Does  he  play  normally  ? 


C.    Nervous  Conditions 
Is  the  child  good-tempered  ? . 


Is  he  free  from  abnormal  emotion?. 


Yes 


No 


*  Indicate  answers  by  a  check  mark. 
Answer  as  many  questions  as  possible. 


ii8 


EDUCATIONAL  HYGIENE 


9- 

lO. 


Does  he  have  good  powers  of  muscular  co-ordina- 
tion ? 

Is  the  child  free  from  spasmodic  movements? 

Is  he  free  from  the  nail-biting  habit  ? 

Does  he  speak  without  stammering  ? 

Is  he  free  from  pronounced  peculiarities  such  as  ir- 
ritability, timidity,  embarrassment,  cruelty,  mo- 
roseness,  fits,  general  misbehavior,  etc.  ? 

Is  he  apparently  free  from  bad  sexual  habits? 

Is  he  free  from  so-called  "  bladder  trouble"  (requests 
to  "go  out")? 

Is  he  usuallj'^  free  from  headache? 


Yes 


No 


D.    Teeth 

1.  Are  the  teeth  clean-looking? 

2.  Are  the  teeth  sound-looking? 

3.  Are  the  six-year  molars  in  good  condition? 

4.  Has  the  child  been  to  a  dentist  within  six  months?. 

5.  Are  the  teeth  regular? 

6.  Does  the  child  use  a  tooth-brush  every  day? 

7.  Are  the  gums  free  from  abscesses? 

8.  Are  the  gums  healthy-looking  ? 

9.  Are  the  upper  teeth  straight  (not  prominent)  ?  . . .  . 
10.  Have  decayed  teeth  been  filled  ? 


E.     Nose  and  Throat 

1.  Does  the  child  breathe  with  the  mouth  closed  ? . 

2.  Is  he  free  from  chronic  nasal  discharge? 

3.  Is  he  free  from  "nasal  voice"? 

4.  Has  he  a  well-developed  face  ? 

5.  Has  he  a  well-developed  chin  ? 

6.  Has  he  straight,  even  teeth  ? 

7.  Is  the  child  mentally  alert? 

8.  Is  he  usually  free  from  sore  throat  ? 

9.  Is  the  hearing  good  ? 


F.    Ears 

Does  the  child  usually  answer  questions  without 

first  saying  "What"? 

Is  he  fairly  attentive? 

Is  he  fairly  bright-appearing  (not  stupid)  ? 


INITIATING   EDUCATIONAL  HYGIENE 


119 


Does  he  have  a  voice  with  good  expression  (not  ex- 
pressionless) ? 

Does  he  spell  fairly  well  ? 

Does  he  read  fairly  well  ? 

Is  he  free  from  complaints  of  earache  ? 

Is  he  free  from  ear  discharge  ? 

Is  he  free  from  any  peculiar  postures  which  might 
indicate  deafness  ? 


G.    Eyes 


Are  the  child's  eyes  straight  ? 

Is  he  free  from  chronic  headache  ? 

Does  he  do  his  work  without  fatigue  ? 

Is  he  free  from  squinting  or  frowning? 

Is  the  child  free  from  postures  which  might  indicate 

eye  defects,  such  as  leaning  over  too  near  the 

desk,  holding  the  head  on  one  side,  etc.  ? 

Are  the  eyes  free  from  redness  and  discharge? 

Are  the  eyelids  healthy-looking? 

Can  the  child  read  writing  on  the  board  from  his 

seat  ? 

Have  the  eyes  been   tested  separately  with   the 

Snellen  Test  Type  ? 


H.     Communicable  Diseases  of  the  Skin 

Is  the  head  free  from  any  signs  of  disease  (lice,  ring- 
worm) ? 

Is  the  skin  healthy-looking? 


I.    Eruptive  Children's  Diseases 

Is  the  child  free  from  the  following  general  early  indica- 
tions of  contagious  diseases? 

1 .  Flushed  face 

2.  Lassitude 

3.  Vomiting 

4.  Eruptions ■ 

5.  Congested  eyes 

6.  Discharging  eyes 

7.  Nasal  discharge 

8.  Persistent  cough 

9.  Scratching 

10.     Sleepiness 


Yes 


No 


I20 


EDUCATIONAL  HYGIENE 


The  following  points  often  indicate  the  early  signs  of  transmissible 
diseases  in  children.  They  will,  of  course,  not  ordinarily  be  observed 
at  the  time  of  making  this  Health  Survey. 

1.  Flushed  face.  6.     Nasal  discharge. 

2.  Lassitude.  7. 

3.  Vomiting.  8. 

4.  Eruptions.  9. 

5.  Red  eyes.  10. 


Persistent  cough. 
Scratching  of  the  skin. 
Sore  throat. 
General  aches  and  pains. 


Teachers  may  use  their  own  judgment  about  this  test. 


Summary 


Physical  development. 

Nervous  system 

Nutrition 

Mental  condition 

Eyes 

Ears 


Nose 

Throat 

Teeth 

Skin 

Eruptive  disease. 

Food 

Ventilation 

Coffee  habit 

Tea  habit 


Remarks 


From  these  individual  forms  the  summaries  may  be  made. 
The  standard  classification,  terminology,  code  numbers,  and 
probable  frequency  of  serious  ailments  given  in  Chapter  VIII 
may  be  used  for  the  ailments  and  defects  discovered. 

(b)  School  Sanitation. — ^There  are  several  forms  on  which 
the  non-expert  person  may  make  a  reasonably  able  survey 
of  sanitary  conditions.  Doctor  Ayres  gives  two  brief  forms 
in  his  survey  of  the  Springfield,  III.,  public  schools.     Other 


INITIATING   EDUCATIONAL   HYGIENE  121 

lorms  will  be  found  in  the  report  of  the  Ohio  School  Survey 
and  in  Bulletin  524  of  the  Bureau  of  Education.  The  chapter 
on  School  Sanitation  Standards  in  this  volume,  as  well  as  the 
chapter  on  Rural  School  Sanitation,  should  prove  helpful.^ 
These  forms  are  suggestive  and  the  good  points  of  many 
may  be  put  together  by  the  principal  or  superintendent  for 
local  use. 

By  this  means  the  superintendent  may  obtain  in  com- 
pact form  the  sanitary  status  of  his  buildings  and  grounds. 
If  some  of  the  board  members  can  be  enlisted  to  help  apply 
modern  standards  to  the  buildings  included  in  the  survey, 
it  may  be  of  strategic  importance.  If  discussion  arises,  the 
superintendent  should  have  some  authoritative  text-book  on 
school  hygiene,  including  school  sanitation,  ready  at  hand. 
Dresslar's  book,  published  by  Macmillan,  will  be  found  help- 
ful. The  survey  of  the  Portland,  Ore.,  school  system  will 
be  suggestive  (health  phases  made  by  Professors  Terman  and 
Dresslar).^ 

School  Sanitation  Forms  Used  by  Doctor  Ayres 
I.     PHYSICAL  PLANT  AND  EQUIPMENT,  BUILDINGS 


Building Principal 

Total  number  of  sittings  in  classrooms 

Seating  capacity  of  assembly-room , 

Average  attendance:  boys girls 

Average  enrolment :  boys girls 

Classrooms:  First  floor Second  floor Third  floor. 

Total  classrooms 

Has  principal  room  for  office?.  .  .  .Location  of  assembly-room. 
Heating  system:  hot-air  furnace,  direct  steam,  indirect  steam. 
Thermostatic  regulation Humidification 


'  See  the  form  used  by  the  Philadelphia  Board  of  Health,  and  the  author's 
article  on  "The  Standardization  of  the  Rural  School  Plant,"  in  School  and 
Society,  for  February  13,  191 5. 

'  The  Rural  School  Hygiene  Survey  of  the  Rural  Schools  of  Pennsylvania, 
made  by  the  author,  deals  with  all  five  divisions.  It  may  be  found  in  the 
Report  on  Rural  Schools,  State  Superintendent  N.  C.  Schaeffer,  Harrisburg, 
Pa.,  Chairman. 


122  EDUCATIONAL  HYGIENE 

Ventilation:  window,  gravity,  plenum  fan,  exhaust  fan 

Location  of  fresh-air  intake Location  of  cloakrooms 

How  ventilated Location  of  toilets 

Toilets:  Number  seats  for  boys.  .  .  . Number  seats  for  girls 

Automatic  flush 

Number  of  individual  urinals  for  boys 

Do  urinals  have  automatic  flush  ? 

Material  of  walls  and  divisions  of  urinals.  .  .  .of  toilet  floors 

Number  feet  of  urinal  trough.  .  .  .Material  of  urinal  trough 

Number  of  wash-basins ....  Individual  soap  provided 

Individual  towels 

Number  of  bubbling  fountains. .  .  .How  often  are  windows  washed?. 

System  of  cleaning  employed 

How  often  are  floors  washed  ? .  . .  .  Are  floors  oiled  ? 

Stairways  of  fireproof  material  ? . .  . .  Are  stairways  enclosed  ? 

Material  of  enclosure. . .  .Hand-rails  both  sides. . .  .Centre  hand-rail. 

Width  of  stairways:  first  floor second  floor 

Width  of  steps 

Height  of  risers ....  Width  of  corridors ....  Corridors  unobstructed  . . 

Fire-escapes:  number  and  kind 

Signal  connection  with  fire  department.  .  .  .Inside  hose  equipment. . . 

Chemical  extinguishers Automatic  sprinklers 

Automatic  fire-alarm 

Heating  plant  separated  by  fireproof  walls,  ceilings,  and  floors  ? 

Is  building  of  fireproof  construction? 

Of  fire-retarding  construction  ? 

Material  of  outside  walls  of  building.  . .  .of  floor  beams 

Gymnasium  facilities Area  of  playground 

Area  of  site Area  of  space  occupied  by  building 

Date  of  construction 

Sheet  S}4  by  ii  Inches 


II.     PHYSICAL  CONDITIONS  OF  CLASSROOMS 

Building Teacher Room  No Grade , 

Av.  attendance  . . .  .No.  sittings:  adjustable. . .  .Non-adjustable. . . .. 

Total 

Length ft.     Width ft.     Height ft.     Floor  area sq.  ft. 

Cubic  contents.  . .  .cub.  ft. 

Square  feet  of  floor  area  per  sitting.  . .  .sq.  ft. 

Cubic  feet  of  air  space  per  sitting. . .  .cub.  ft. 

Total  window  area.  .  .  .sq.  ft. 

Distance  from  top  of  window  to  floor. . .  .ft. 


INITIATING  EDUCATIONAL  HYGIENE  1 23 

Square  feet  of  floor  area  for  each  square  foot  of  window  area. . .  .sq.  ft. 

Windows  at  left,  back,  right,  or  front  of  children 

Lineal  feet  of  blackboard.  .  .  .ft.     Lineal  feet  per  sitting.  .  .  .ft. 

Inches  from  base  of  blackboard  to  floor.  .  .  .inches. 

Do  seats  project  under  front  edge  of  desk?.  .  .  .How  far?.  .  .  .inches. 

How  many  pupils  cannot  easily  rest  feet  on  floor  ? 

Distance  from  rear  seat  to  rear  wall.  .  .  .ft. 

Color  of  walls ....  Color  of  ceilings ....  Color  of  window-shades 

Do  shades  roll  from  top  or  bottom?. .  .  .Has  room  a  thermometer?. . . 
Card  4  by  6  Inches 

(c)  Physical  Education. — We  can  call  attention  here  to  no 
good  forms  for  investigating  physical  education.  The  calis- 
thenics, plays,  and  games  used,  their  supervision,  kinds  of 
play  apparatus,  kind  of  room  calisthenics,  two-minute  exercise 
drills,  games  used  in  the  schools,  size  of  school  playgrounds, 
athletics  and  their  supervision,  proportion  of  student  popu- 
lation reached  effectively  by  physical-education  department, 
number  and  training  of  physical-training  and  other  physical- 
education  teachers  and  supervisors,  the  extent  to  which 
physical-education  instructors  discover  ailments  and  defects, 
school  bathing  and  swimming,  athletic  leagues,  folk-dancing, 
etc.,  will  be  considered.  Curtis's  books  on  ''Play  and  Rec- 
reation" and  "Education  Through  Play"  will  be  helpful 
here;  Hkewise  the  Playground  Magazine  (No.  i  Madison 
Avenue,  New  York  City),  and  a  bulletin  issued  by  the  State 
Department  of  Public  Instruction  of  Virginia  on  Play  and 
Athletics,  showing  desirable  home-made  apparatus  and  plays 
and  games.  Another  bulletin  on  Recreation,  by  the  State 
Department  of  Education  of  Oregon,  and  the  bulletin  of  the 
United  States  Bureau  of  Education  on  Play,  are  also  desir- 
able. Rapeer's  "School  Health  Administration"  has  a  chap- 
ter on  this  problem. 

{d)  The  Teaching  of  Hygiene. — For  this  we  have  no  good 
forms,  although  several  surveys  have  considered  the  matter, 
e.  g.,  those  of  Ohio,  Portland,  Ore.,  and  Vermont.  This 
would  include  the  kind  and  quality  of  text-books  used,  the 
amount  of  attention  paid  to  the  formation  of  good  health 


124  EDUCATIONAL  HYGIENE 

habits,  such  as  cleanUness  of  person,  tea  or  coffee  drinking, 
sufficiency  of  sleep,  ventilation  of  sleeping-rooms  at  night,  etc., 
as  well  as  attention  to  the  provision  of  washing  facilities, 
liquid  soap,  paper  towels,  toilet-paper,  and  sanitary  drinking 
fountains  at  schools.  It  would  include  the  time  on  the 
daily  programme  devoted  to  instruction  in  hygiene,  the 
efficiency  of  the  methods  used,  and  the  amount  of  correlation 
with  other  subjects.  The  chapters  in  this  volume  on  the 
"Teaching  of  Hygiene"  in  elementary  and  high  schools,  in 
the  author's  volume  on  "Teaching  the  Elementary  School 
Subjects,"  and  the  May,  191 2,  number  of  the  Teachers  Col- 
lege Record  (Columbia  University),  on  ''Health  Instruction 
in  the  Elementary  School,"  by  Professor  Reesor,  will  prove 
helpful. 

{e)  The  Hygiene  of  Methods  oj  Teaching  and  Manage- 
ment.— Here  we  have  problems  concerning  the  daily  and 
weekly  programme  as  to  proper  alternation  of  subjects, 
proper  time  of  day,  suitable  time  between  work  periods, 
the  hygiene  of  vision,  including  reading  from  bad  type,  the 
placing  of  children  with  defective  vision  and  hearing  at  the 
back  rather  than  the  front  of  the  room,  etc.  They  cannot 
be  well  surveyed  at  present.  Doctor  Beik's  two  chapters  in 
this  volume  will  prove  suggestive.  Professor  Terman  has  a 
volume  announced  on  this  interesting  topic,  namely,  "The 
Hygiene  of  Instruction."  Dresslar  has  a  chapter  on  the 
subject  in  his  "School  Hygiene."  This  division  may  be 
omitted  in  the  preliminary  survey,  however,  if  desired.  If 
teachers,  principals,  and  superintendent  do  their  work  well 
with  the  first  four  phases  of  the  survey  of  educational  hy- 
giene, much  will  be  accomplished. 

(5)  Public  Co-operation. — When  the  school  people  have 
submitted  themselves,  their  pupils,  and  their  environment  to 
such  scrutiny,  in  the  light  of  the  school-health  standards 
available,  they  can  proceed  to  do  much  along  all  five  lines  of 
educational  hygiene  without  calHng  upon  the  board  for  ex- 
penditures of  money.     However,  their  work  will  necessarily 


"^  INITIATING   EDUCATIONAL  HYGIENE  1 25 

be  somewhat  faulty,  especially  along  medical  lines.  Parents 
can  be  visited  in  the  homes  by  teachers  as  well  as  by  nurses, 
of  course,  but  the  training  of  the  nurse  and  the  fact  that 
she  is  a  nurse,  or  is  called  "nurse,"  will  give  her  an  advan- 
tage. The  examination  by  a  physician,  especially  with  the 
parents  present,  adds  much  to  the  effectiveness  of  the  work 
of  medical  supervision.  Then,  too,  in  cities  above  10,000 
population  there  is  need  of  a  single  school  health  supervisor 
who  can  supervise  all  phases  of  educational  hygiene. 

At  this  stage,  then,  it  is  desirable  to  have  direct  public 
co-operation  for  instituting  a  trial  nurse,  doctor,  school  den- 
tist, all  at  once  or  in  pairs.  Most  school  features  have  been 
initiated  in  this  manner,  namely,  first  a  trial  on  a  limited 
scale  paid  for  and  inaugurated  by  private  groups  or  individ- 
uals; demonstrated  success,  or  general  conviction  that  the 
feature  is  desirable  as  a  part  of  public-school  work;  and,  third, 
the  adoption  of  the  measure  and  its  support  by  public  taxation. 

Here  a  strong  parent- teachers'  organization,  or  several 
of  them,  may  be  formed  to  promote  this  work.  Dues  may  be 
charged  and  donations  collected.  Women's  clubs  and  vari- 
ous private  organizations  may  be  appealed  to  in  various 
ways.  Elsa  Denison's  book  on  "Helping  School  Children" 
and  Mrs.  Cabot's  book  on  "Volunteer  Help  to  the  Schools," 
as  well  as  Mr.  Perry's  chapter  in  this  volume  and  his  book  on 
"The  Wider  Use  of  the  School  Plant,"  will  be  of  great  as- 
sistance here.  Dresslar's  chapters  in  the  191 2  and  1913 
Reports  of  the  United  States  Commissioner  of  Education 
will  also  give  much  help.  The  superintendent  should  make  a 
survey  of  the  city  to  discover  all  possible  individuals,  groups, 
and  organizations  that  will  help.  Sometimes  national  bodies 
can  be  called  in  to  assist  without  expense,  and  at  other  times 
the  business  men's  club  or  commercial  club  will  take  the 
matter  up,  as  the  Chicago  Club  has  the  matter  of  vocational 
education.  Such  an  investigation  need  not  take  long.  The 
idea  is  democratic  advance  through  public  awakening  and  group 
initiation  of  new  mecLsures — genuine  school  leadership. 


126  EDUCATIONAL   HYGIENE 

(6)  Volunteer  or  Partly  Paid  Specialists. — Along  with 
this  will  come  the  appeal  to  the  dentists',  physicians',  and 
nurses'  organizations  for  voluntary  or  partly  paid  work  in  the 
schools.  A  group  of  physicians  can  often  be  procured  each 
individual  of  which  will  offer  his  services  for  a  certain  number 
of  two-hour  periods  during  the  year  on  a  schedule  made  by 
the  superintendent,  the  latter  to  notify  each  physician  ahead 
of  time.  The  same  may  be  done  for  nurses  and  dentists.  A 
nurse  may  be  loaned  for  part  time  by  the  visiting  nurses'  or- 
ganization while  the  other  part  of  the  time  may  be  paid  for 
by  the  school  associations  from  the  voluntary  fund.  If  possi- 
ble, a  full-time  nurse  should  be  employed  to  begin  with.  Later 
a  part-time  physician  may  be  employed.  One  nurse  for  each 
1,500  pupils  and  one  physician  two  hours  a  day  for  each  2,500 
pupils  are  good  standards. 

(7)  Public  Adoption. — Through  this  voluntary  demonstra- 
tion the  ground  has  been  broken  for  the  final  step  of  school- 
board  support.  With  the  public  aroused  and  acquainted  with 
the  facts,  with  constant  newspaper  articles  and  pictures, 
with  budget  exhibits  and  play  pageants,  with  records  of 
lowered  retardation  and  elimination  figures,  and  fewer  cases 
of  disease  and  death,  most  boards  will  move  forward  to  oc- 
cupy the  ground  broken  by  private  initiative,  led  by  the 
superintendent.  Such  leadership  is  real  statesmanship  and  is 
of  a  far  higher  type  than  the  more  obvious  kinds  often  going 
on  under  the  name  of  politics,  war,  diplomacy,  and  the  Hke. 


CHAPTER  VIII 

THE  GENERAL  ADMINISTRATION  OF  EDUCATIONAL 

HYGIENE 

Facing  the  Health  Issue. — The  general  health  problem, 
which  has  been  sketched  in  previous  chapters  from  the  stand- 
point of  social  economy,  has  in  a  more  or  less  vague  way, 
during  the  last  decade,  been  rapidly  rising  in  the  national 
consciousness.  Leaders  in  great  numbers  in  all  parts  of  the 
country  have  rather  suddenly  awakened  to  the  fact  that 
the  most  important  human  asset  we  possess  is  being  wasted 
and  destroyed  in  the  most  thoughtless  manner,  and  that  the 
most  important  kind  of  conservation  of  natural  resources  in 
which  we  in  America  may  engage  is  that  of  the  conservation 
and  development  of  our  national  health  and  vitality.  The 
progress  of  science  has  developed  in  many  and  marvellous 
ways  an  unparalleled  array  of  instrumentalities  for  over- 
coming death,  disease,  and  physical  imperfection.  Where 
we  once  sat  in  darkness  and  shivering  fear  at  the  terrible 
mysteries  which  robbed  us  of  life,  health,  and  happiness 
there  is  now  an  increasing  light.  The  work  of  Pasteur,  of 
Koch,  of  Reed,  of  Galton,  and  many  other  scientific  students 
of  Ufe  and  health  has  borne  glorious  fruit  not  only  in  remark- 
able additions  to  human  knowledge  but  in  an  increasing 
number  of  men  and  women  working  in  the  laboratories  of 
Hfe  wherever  the  problem  of  health  and  vitality  may  be  con- 
cretely and  intimately  met  and  studied. 

By  these  various  means  we  have  come  to  the  amazing 
spectacle  of  an  enlightened  people  in  need  of  these  health 
principles  in  their  daily  life  and  practise  and  yet  from  ten 
to  forty  years,  in  general,  behind  the  chariot  of  Truth  drawn 

127 


128  EDUCATIONAL  HYGIENE 

forward  so  rapidly  by  the  small  number  who  are  her  devotees. 
The  new  health  science  is  produced  and  kept  in  the  pos- 
session of  but  a  very  few,  while  the  old  mores  and  customs  of 
the  people  remain  largely  untouched.  To  make  this  knowl- 
edge common  property  and  daily,  Kving  practise,  to  create 
and  foster  more  agencies  for  learning  the  truth  regarding 
health  and  vitality,  and  to  discover  how  new  health  standards, 
ideals,  and  practises  may  be  so  inculcated  in  the  daily  lives 
of  the  many  as  appreciably  to  improve  the  health  and  vigor 
of  our  nation — these  are  the  problems  of  educational  hygiene. 

Public-Health  Improvement. — In  these  few  early  years 
of  the  twentieth  century,  as  suggested,  the  anomaly  here 
presented  has  been  sensed  by  many  leaders  in  many  lines  of 
work.  Newspapers  and  magazines  have  taken  up  the  problem, 
public  opinion  has  been  in  many  places  aroused,  and  the 
public-health  spirit,  which  has  been  dormant  throughout  the 
long  health  dark-ages  since  the  early  Greeks  revered  Hygieia, 
has  come  by  a  new  birth  again  into  its  rightful  position  among 
the  values  of  life.  The  first  vague  stirring  of  this  new  health 
spirit  has  been  evidenced  in  a  most  interesting  and  excep- 
tional heterogeneity  of  efforts  directed  toward  the  discovery 
of  the  specific  nature  of  our  health  problems  and  the  best 
methods  of  solution.  The  playground  movement,  the  anti- 
tuberculosis campaigns,  the  movement  toward  registration  of 
births  and  deaths,  the  various  health  philanthropies  of  an 
investigative  and  curative  nature,  such  as  those  of  Rocke- 
feller, Forsythe,  Sage,  Carnegie,  and  many  others,  the  school- 
medical-inspection  movement — these,  and  hundreds  of  others, 
have  in  infinite  \'ariety  sprung  up  spontaneously  to  fight  down 
the  enemies  of  health. 

In  the  schools  these  various  health  and  development 
measures  have  been  introduced  by  many  agencies  for  many 
purposes.  At  present  they  appear  to  many  as  a  host  of 
uncorrected,  poorly  manned,  and  poorly  directed  agencies, 
little  beyond  the  stage  of  miscellaneous  fads.  There  is,  for 
example,  the  present  great  and  important  interest  and  effort 


ADMINISTRATION   OF   EDUCATIONAL  HYGIENE        1 29 

along  the  line  of  the  psychological  examination,  treatment, 
and  education  of  mentally  deficient  or  exceptional  children; 
there  is  the  movement  for  better  school  sanitation,  including 
better  ventilation  and  lighting,  the  aboKtion  of  common 
drinking-cups  and  common  towels,  etc.;  the  provision  of 
playgrounds  for  all  children;  the  creation  of  school  clinics, 
and  medical  inspection  and  examination;  and  many  others. 
The  onlooker  who  sees  these  agencies  as  miscellaneous,  weak, 
uncorrected,  and  largely  inefficient  undoubtedly  sees  them 
aright,  for  these  adjectives  truly  describe  them.  As  such,  the 
situation  furnishes  us  a  social  emergency.  For  the  danger  is 
that  the  first  weak  and  halting  steps  in  any  of  these  various 
directions  may  be  taken  as  permanent  standards,  as  has  so 
often  happened ;  also  that  the  development  may  be  one-sided 
and  faddish,  that  important  agencies  will  languish  and  die 
out,  that  the  work  may  be  wasteful  and  expensive,  and  that 
the  whole  health  movement,  now  so  promising,  may  largely 
fail  because  it  has  not  risen  to  the  hopes  and  needs  of  the  times. 

School-Health  Principles. — The  efficiency  of  these  various 
agencies  in  the  schools  is  the  topic  of  this  chapter.  Scien- 
tific management  in  business,  the  success  due  to  organization 
and  correlation  of  scattered  parts  in  great  corporations,  the 
supreme  importance  of  supervision  and  leadership  as  well  as 
professionally  trained  workers  in  the  schools,  and  the  scien- 
tific and  democratic  needs  and  tendencies  of  the  times,  all 
furnish  suggestions  for  lowering  the  cost  and  increasing  the 
efficiency  of  school-health  work.  Some  of  the  important  and 
essential  principles  seem  to  be  as  follows: 

(i)  School  health  and  development  work  is  a  specialty 
and  must  be  placed  in  the  hands  of  those  specially  educated 
for  this  service.  This,  however,  will  not  displace,  but  make 
more  efficient,  the  teachers,  principals,  and  supervisors. 

(2)  The  various  phases  of  school-health  work  must  in 
each  school  system  be  organized  into  a  single  department 
centred  on  the  solution  of  the  school-health  problem. 

(3)  The  professional  training  of  teachers  must  henceforth 


I30 


EDUCATIONAL  HYGIENE 


include,  as  at  least  correlative  with  educational  psychology, 
the  study  and  practise  of  educational  hygiene. 

(4)  These  teachers  and  the  doctors,  nurses,  dentists, 
oculists,  and  psychologists  must  have  expert  leadership  and 
supervision. 

(5)  The  adult  pubhc  must  be  educated  through  the 
schools;  and,  finally, 

(6)  The  parents  and  general  public  must  be  helped  as 
never  before  to  co-operate  for  school-health  progress,  not 
only  for  the  sake  of  the  children  and  the  schools,  but  for 
their  own  educational  participation. 

The  Divisions  of  Educational  Hygiene. — We  cannot  here 
support  at  length  these  generahzations.  To  a  large  extent 
they  seem  self-evident  to  any  one  acquainted  with  the  actual 
conditions  in  the  schools  and  the  actual  successes  of  many 
able  educational  and  other  leaders.  They  are  fairly  general 
principles  underlying  the  success  of  practically  any  public 
agency  in  a  democracy.  Of  all  agencies  the  pubUc-school 
systems  of  the  country  should  for  many  and  sufficient  reasons 
be  most  democratic  and  most  efficient.  We  shall  attempt  in 
the  following  pages  and  chapters  to  sketch  broadly  the 
methods  by  which  the  various  factors  may  be  correlated  in 
the  service  of  school  and  national  health. 

Now,  what  are  the  more  immediate  ends  to  which  the 
schools  should  direct  their  efforts  in  this  work?  We  might 
give  a  Ust  such  as  fresh  air,  good  food,  sleep,  clothing,  sun- 
light, recreation,  freedom  from  maUgnant  germs,  etc.  A 
number  of  organizations  of  these  health  factors  might  be 
made.  Burk's  book  on  "Health  Work  in  the  Schools"  has 
something  of  the  above  outhne.  Of  the  many  possible  we 
choose  the  following  because  of  its  simpHcity,  its  practicabihty, 
and  its  ease  of  introduction,  namely: 

(i)  Determining  the  actual  physical  and  mental  nature 
of  the  children  as  measured  by  the  normal  or  typical,  with 
necessary  remedial  measures.  This  will  practically  mean  a 
health  census  of  school-children,  with  special  reference  to  the. 


ADMINISTRATION   OF   EDUCATIONAL  HYGIENE        131 

pathological,  actual  and  incipient,  and  to  the  exceptional. 
This  division  will  determine  the  actual  physical  condition  of 
children  and  attempt  to  get  them  placed  in  normal  condi- 
tion. The  best  name  for  a  division  to  work  in  this  field  yet 
suggested  seems  to  be  that  of  Medical  Supervision. 

(2)  Providing  a  hygienic  school,  home,  and  community 
environment.  On  the  basis  of  what  is  learned  of  the  physical 
nature  of  children  there  can  be  gradually  developed  for  them 
an  environment  that  will  promote  health  and  normal  physical 
development.  The  best  name  at  present  for  this  division  is 
the  common  one,  School  Sanitation. 

(3)  Providing  for  the  development  of  splendid  bodily 
resistance  and  a  healthy,  happy  body  and  mind,  including 
medical  gymnastics,  play,  physical  training,  certain  forms  of 
recreation,  and  others.  The  best  name  for  this  division  ap- 
pears to  be  Physical  Education. 

(4)  When  we  have  learned  the  actual  physical  condition 
of  the  children  and  have  put  them  into  fairly  normal  con- 
dition, after  we  have  provided  a  hygienic  environment  for 
them,  and  after  they  are  provided  with  wholesome  physical 
education,  then  there  comes  a  fourth  division  devoted  to 
teaching  the  pupils  the  principles,  the  ideals,  and  many  of 
the  habits  of  health.  This  division  may  be  termed  merely  the 
Teaching  of  Hygiene. 

(5)  But  more  is  needed  than  medical  supervision,  school 
sanitation,  physical  education,  and  the  teaching  of  hygiene. 
We  may  put  the  children  into  good  physical  condition,  in  a 
hygienic  environment;  we  may  furnish  them  with  excellent 
physical  education,  and  provide  skilled  teachers  of  hygiene; 
and  yet  the  methods  of  handhng  the  children,  the  methods  of 
teaching,  examining,  training,  and  curing,  may  be  such  as 
to  promote  worry,  exhaustion,  fear,  and  many  other  unhy- 
gienic symptoms.  A  neurasthenic  and  "cranky,"  though 
scholarly,  teacher  may  injure  the  health  of  children  by  bad 
methods.  This  division  deals  with  the  hygiene  of  methods,  or 
as  it  is  commonly  termed,  perhaps,  The  Hygiene  of  Instruction. 


132  EDUCATIONAL  HYGIENE 

The  plate  accompanying  gives  a  rough  idea  of  this  organ- 
ization. 

Now,  when  we  have  analyzed  out  these  five  functions 
and  created  divisions  of  effort  and  attention  to  promote 
them,  we  have  a  fairly  complete  organization.  Some  may 
object  to  the  placing  of  the  work  of  the  clinical  psychologist 
under  medical  supervision.  However,  this  is  a  picture  of  the 
actual  development  now  going  on  in  this  country  and  abroad, 
and  seems  based  on  good  scientific  and  practical  grounds. 
When,  perhaps,  the  use  of  the  Binet  and  other  tests  of  in- 
telligence, the  special  classes  for  mentally  subnormal  and 
mentally  gifted,  and  the  whole  clinical  psychology  technique 
is  better  developed  and  manned  than  at  present,  there  will  be 
created  in  many  large  school  systems  this  separate  division 
as  an  actual,  outward  reality.'  We  leave  it,  however,  for  the 
present  with  the  medical  supervision  in  the  confidence  that 
the  physicians,  dentists,  nurses,  and  psychologists  can  work 
together  very  well  in  the  service  of  the  exceptional,  or  sub- 
normal, children,  physical  and  mental. 

It  may  also  be  said  that  the  Hygiene  of  Teaching  belongs 
here  as  a  separate  division.  This  is  the  hygiene  of  an  occu- 
pation, teaching,  and  it  is  of  great  importance  financially 
and  educationally  and  much  neglected.  Terman  has  em- 
phasized it  in  his  little  book  on  ''The  Health  of  the  Teacher." 
But  the  teacher  needs  all  that  the  pupils  need:  medical  ex- 
amination periodically,  any  necessary  treatment,  physical 
education,  especially  recreation,  a  healthful  environment  in 
which  to  work,  education  along  the  lines  of  health,  and  such 
supervision  and  administration  as  will  promote  her  best 
work  and  health,  not  their  opposites  as  so  often  happens. 
Through  the  efforts  of  the  Life  Extension  Institute  many 
business  organizations  are  using  similar  methods  of  guarding 
the  health  of  their  workers.  The  State  is  even  more  bound 
to  exercise  such  care.  Teachers,  janitors,  and  others,  then, 
may  be  dealt  with  in  the  five  divisions  given.  In  short,  these 
five  divisions  seem  practically  and  scientifically  justified. 

'  As  in  St.  Louis  and  certain  other  cities. 


THE  DIVISIONS  OF  EDUCATIONAL 
HYGIENE 

Supervisor  of  Hygiene 


MEDICAL 
SUPERVISION 


INSPECTIONS 
AND        ANNUAL 
EXAMINATIONS 


DISCOVBRINO 
HEALTH 

NEEDS. 

CO-OPERATINO 
WITH      BOARDS 
OP    HEALTH 
AND     PRIVATE 
OROANIZA- 
TIONS. 

OPEN    AIR 
SCHOOLS. 
LIMITING 
DOCTORS    TO 
EXAMINA- 
TIONS, 

B0PERVIS1ON 
OP    NURSES 
AND    WORK 
IN   CLINICS. 

PSYCHOLO- 
GISTS. 
OCULISTS. 
SURGEONS, 

DENTISTS. 
PHYSICIANS. 

SUPERVISION 
or    SCHOOL 
FEEDING. 

SCIENTIFIC 
STUDIES    OP 
PREVENTION 
AND     CAUSE 
OF    DISEASE. 

CAREFUL 

RECORDS 

EMPHASIZmO 

SERIOUS 

AILMENTS 

FOUND    AND 

CURED. 

TRAINING 
SCHOOL 
NURSES    FOB 
ALL    INSPEC- 
TION   AND 
EXAMINATION. 
NURSES   AS 
ATTENDANCE 
OFFICERS. 


SCHOOL 
SANITATION 


SCHOOL    SITES 
AND     ARCHI- 
TECTURE. 

VENTILATION. 


DRINKING 
WATER    AND 
FOUNTAINS. 


HTOIENIC 

TOILET 

FACILITIES. 


DECORATION. 

THE  STAND- 
ARD SCHOOL 
BOOM. 

PIRE-PROOP 
CONSTRUC- 
TION. 

HEALTH.  REST. 
AND     EMER- 
GENCY    ROOMS. 

PLAYROOMS 
AND  ROOF 
PLAYOROUNDa 


DRYING    AND 

WARMING 

SEATS. 

TNVESTIGA- 
TIONS  OF  RE- 
CIRCULATION, 
HUMIDITY, 
AIR-CLEAN- 
ING, DISIN- 
FECTION, BTC. 


PHYSICAL 
EDUCATION 


PHYSICAL 
TRAINING 
AND  GYM- 
NASTICS. 


POSTURE  AND 
CORRECTIONAL 
EXBRCISBB. 

ASSISTING 
IN    MEDICAL 
SUPERVISION. 

RECREATION. 

SCHOOL 
EXCURSIONS 
AND     TRAMPS. 

BOY    SCOUTS 
AND    CAMP 
FIRB    GIRLS. 

GYMNASIUMS 
AND    ATHLETIC 
FIELDS. 


POOLS.     SHOW- 
ERS   AND 
BEACHES. 


PHYSICAL 
EDUCATORS 
WITH    MEDICAL 
KNOWLEDGE. 


PAY   FOR 
SUPERVISING 
PLAY  AFTER 
SCHOOL    AND 
SATURDAYS. 

CULTIVATING 
THE    GREEK 
IDEAL    OF 
PHYSICAL 
AND     MENTAL 
PERFECTION. 


TEACHINC 
HYGIENE 


HEALTH     EDU- 
CATION   OF 
TEACHERS. 

ADVISING 
CHOICE     OF 
BEST    HYGIENE 
TE.XTS    AND 
TOPICS. 
FORMING 
PERSO.N'AL 
HYGIENE 
HABITS. 

PUBLIC 
HYGIENE 
STUDY    AND 
CO-OPERATION. 

HEALTH   EDU- 
CATION   OP 
PARENTS. 
FEEDING. 
CLOTHING 
AND     SLEEP 
OF     CHILDREN. 

HOME  HYOIENK 

IN    DOMESTIC 

SCIENCE. 

VOCATIONAL 

HYGIENE     IN 

INDUSTRIAL 

SUBJECTS. 

TALKS    BY 
DOCTORS, 
NURSES    AVD 
SPECIALISTS. 

FIRST    AID. 
SEX    HYGIENE 
STUDYING 
COM.MU.VlTT 
HEALTH 
PROBLEMS 
A.VD     METHODS 
OP    IMPROVE- 
MENT. 

DAILY    ORAL 
QUESTION- 
NAIRE  ON 
HOME 
HYGIENE: 
USE    OF 
TOOTH-BRUSH, 
COFFEE 
DRINKING, 
VE.N'TILATION, 
ETC. 
HEALTH 
KNOWLEDOB. 
HEALTH 
IDEALS, 


HYGIENIC 
TEACHINC 

■THI}   HYGIENE 
OP    INSTRUC- 
TION." 

FATIGUE, 
OVER-WORK 
AND    UNDER- 
WORK. 


THE    HYGIENE 
OF    SCHOOL 
SUBJECTS. 


INTER-RECI- 
TATION RE- 
CREATION. 

TRANSFORM- 
ING    NEURAS- 
THENIC    AND 
•CRANKY- 
TEACHERS. 

MOTOR 
ASPECTS    OP 
TEACHING. 


THE    HYGIENE 
OF    JOY     IN 
SCHOOLS. 

PREVENTINO 
PHYSICAL 
DEFECTS     AND 
PATHOLOGICAL 
CONDITIONS. 


TNPLUENCB 
OF    VACA- 
TIONS AND 
HOLIDAYS. 


HYGIENIC 
EFFECTS    OP 
DIFFERENT 
METHODS. 

THE    TEACHER 
AS    MEDICAL 
GUARDIAN. 


134  EDUCATIONAL  HYGIENE 

We  have  now  an  organization  of  the  field  of  educational 
h}'gicne.  How  are  we  going  to  get  these  various  phases  of 
the  service  to  work  together  with  the  greatest  efficiency  and 
the  least  expense?  How  are  we  to  provide  the  expert  super- 
vision and  service  which  we  have  named  as  essential?  With- 
out going  into  the  detail  desirable,  and  attempting  to  avoid 
the  pitfalls  of  devising  a  general  cure-all  for  all  kinds  of  school 
systems,  we  offer  for  consideration  the  following  plan  of  ad- 
ministrative organization: 

The  Administration  of  Educational  Hygiene:  A  Tenta- 
tive Standard  Plan. — School  superintendents  are  not  special- 
ists in  the  field  of  educational  hygiene.  Their  education  has 
generally  been  very  much  lacking  in  training  along  the  lines 
of  the  physical,  rather  than  the  mental,  nature  of  children, 
and  most  of  the  various  health  measures  have  come  into  the 
schools  because  of  pressure  by  organizations  and  individuals 
from  without  school  systems.  The  average  superintendent 
probably  spends  very  much  less  than  one  per  cent  of  his  time 
in  stud>4ng  and  superintending  school-health  work.  As  there 
have  been  added  in  most  progressive  school  systems  super- 
visors of  the  various  special  phases  of  school  work,  so  there 
must  be  supervisors  of  educational  hygiene.  In  the  past,  and 
to  a  large  extent  at  present,  we  have  supervisors  and  teachers 
of  physical  training,  and  supervisors  and  instructors  for  play- 
grounds; doctors  and  nurses  are  rapidly  being  added ;^  dentists, 
oculists,  dermatologists,  psychologists,  and  surgeons  are  being 
provided.  The  regular  teachers  need  education  and  inspira- 
tion along  the  lines  of  health  work.  There  should  be,  then, 
a  specialist  in  the  schools  to  co-operate  with  and  to  lead  the 
many  civic  and  other  bodies  that  have  or  may  take  a  part 
in  school-health  work.  All  these  needs  and  heterogeneous 
agents  furnish  the  problem  for  organization  and  scientific 
management. 

'The  Bureau  of  Education  reported  in  1914  that  of  1,300  cities  with  a  popu- 
lation of  2,500  to  30,000  inclusive  516  cities  report  medical-inspection  systems, 
and  that  86  of  the  516  have  one  or  more  school  nurses. 


ADMINiSTRATION   OF   EDUCATIONAL   HYGIENE         135 

The  only  one  who  can  adequately  organize,  supervise,  and 
make  efficient  these  miscellaneous  instrumentalities  and 
agents  must  be  the  educational  hygienist.  The  educational 
hygienist  should  be  one  who  knows  well  and  can  successfully 
supervise  all  the  manifold  phases  of  school-health  work.  The 
average  physician  is  Httle  versed  in  pediatrics,  and  not  at  all 
in  school  work  and  the  phases  of  educational  hygiene  outside 
of  mere  medical  inspection.  The  average  physical-training 
teacher  or  supervisor  knows  something  of  her  subject,  but 
little  more.  The  educational  hygienist  must  know  the 
schools  and  their  problems;  he  must  either  be  a  physician 
skilled  in  the  field  of  children's  diseases  and  child  hygiene,  or 
an  educator  who  has  had  such  study  and  experience  in  the 
fields  of  school  sanitation,  sociology,  the  phases  of  medical 
training  which  may  function  in  school  medical  supervision, 
in  physical  education,  and,  perhaps,  in  the  two  remaining 
divisions  of  educational  hygiene,  as  will  enable  him  to  super- 
vise all  school-health  work.  The  ordinary  medical  course  is 
a  very  poor  training  for  such  work.  We  need  a  four-year 
course  that  is  designed  especially  to  develop  educational 
hygienists.  Such  a  course  may  be  provided  in  connection 
with  some  progressive  college  for  the  training  of  teachers, 
such  as  Teachers  College,  Columbia  University,  which  is 
now  purely  a  graduate  institution,  in  some  good  medical 
school,  or  in  connection  with  the  courses  that  are  now  pro- 
vided at  the  University  of  Wisconsin,  at  Cambridge,  Eng- 
land, and  elsewhere,  to  educate  doctors  of  pubUc  health — 
D.P.H.  A  teachers  college  near  and  connected  wdth  a  medical 
school  would  make  a  very  desirable  combination. 

Not  having  such  training  courses  as  yet,  we  should  take 
physicians  who  have  had  experience  in  physical  education, 
physician-physical-educators,  or  take  educators  who  have 
had  the  elements  of  a  medical  education  and  who  are  versed 
in  physical  education,  including  normal  diagnosis,  medical 
gymnastics,  play  and  playgrounds,  and  so  on.  The  average 
physician  has  almost  as  far  to  go  in  perfecting  himself  for 


136  EDUCATIONAL  HYGIENE 

this  work  as  has  the  educator.  In  an  effort  to  provide  such 
educational  hygienists  for  several  cities  and  State  depart- 
ments of  education  the  writer  has  found  in  this  country  over 
twenty  available  physicians  who  have  had  sufficient  experi- 
ence in  physical  education  and  school  work  to  make  success 
possible  in  this  new  field.  Several  cities,  such  as  Boston, 
Albany,  Minneapolis,  New  York,  and  others,  have  such  men 
as  supervisors  of  hygiene  for  the  schools,  and  a  number  of 
State  departments  of  education  are  looking  forward  to  pro- 
viding such  officers.  The  State  Board  of  Health  of  Minne- 
sota employed  for  some  time  such  a  hygienist.  Doctor  Hoag, 
who  has  a  chapter  in  this  volume  and  whose  report  of  this 
work  is  printed  by  the  United  States  Bureau  of  Education. 
As  soon  as  universities  estabUsh  chairs  and  departments  of 
educational  hygiene,  similar  to  those  established  at  Clark, 
Stanford,  and  Teachers  College,  Columbia  University,  and  as 
soon  as  more  cities  and  rural  regions  demand  such  school- 
health  officers,  we  shall  have  forthcoming  a  sufficient  supply 
of  eager  and  qualified  young  men. 

Such  an  official  could  be  made  co-ordinate  in  rank  with 
other  supervising  officers  under  the  general  superintendent  of 
schools,  and  could  in  many  places  so  reduce  school  expenses 
as  to  save  his  own  salary.  The  salary  of  such  men  must  be 
between  two  and  four  thousand  dollars,  almost  the  salary  of 
superintendents.  Such  an  official,  however,  can  frequently 
do  the  work  of  several  part-time  physicians,  or  medical  ex- 
aminers or  inspectors;  he  can  frequently  take  the  place  of  one 
or  more  physical- training  teachers  or  supervisors;  he  can  di- 
rect athletics  and  summer  playground  work,  evening  recrea- 
tion centres,  and  pubhc-school  athletic  leagues;  he  can  fre- 
quently direct  the  school  nurses  in  such  a  manner  as  to 
eUminate  one  or  more  special  truant  officers;  and  he  can  make 
the  work  of  the  whole  health  and  development  corps  more 
efficient,  eliminating  waste,  testing  results,  cutting  down 
exclusions  and  illness-absence,  and  consequently  retardation, 
elimination,  and  non-promotion.    The  health  of  the  children 


ADMIN  ISTIL\TION   OF   EDUCATION  AX   HYGIENE         137 

of  the  schools  and  nation  will  not  be  adequately  preserved 
and  developed  until  such  a  definite  organization  and  such 
health  leaders  are  incorporated  in  school  systems.  Efficient 
leadership  furnishes  that  scientific  management,  inspiration, 
and  breath  of  Ufe  necessary  in  all  successful  social  organiza- 
tion, and  the  school  cannot  afford  longer  to  miss  its  advantages 
in  the  fundamental  field  of  health. 

The  United  States  Bureau  of  Education  and  the  English 
and  Scottish  National  Boards  of  Education  at  present  have 
such  supervisors  of  educational  hygiene,  the  last  two  being 
physicians  and  the  first  not.  France,  Germany,  and  Sweden, 
especially  the  last,  have  gone  a  long  way  in  this  direction. 
The  State  Commissioners  of  Education  in  Massachusetts 
and  New  Jersey  have  both  recently  made  efforts  toward 
getting  such  officers  added  to  their  departments  for  State 
supervision.  The  demands  of  economy,  of  leadership,  and  of 
efficiency  will  soon  force  most  other  States  and  most  cities, 
as  well  as  many  rural  regions,  to  supply  such  officers. 

Boards  of  Education,  not  Boards  of  Health. — This  work 
must  be  placed  everywhere,  except  perhaps  in  certain  rural 
regions  for  a  time,  in  the  hands  of  the  boards  of  education, 
not  of  the  boards  of  health.  I  have  treated  this  problem  at 
some  length  in  "School  Health  Administration,"  examining 
all  sides  of  the  question.  Efficiency  cannot  come  through  ad- 
ministering any  part  of  the  school's  work  for  children  by  some 
outside  agency.  Statistics  and  experience  prove  this;  and  the 
tendency  is  everywhere  toward  placing  the  work  in  the  hands 
of  the  boards  of  education.  Doctor  E.  H.  Lewinski-Corwin 
has  shown  that  a  great  factor  in  the  success  of  medical  super- 
N-ision  is  the  degree  of  co-operation  which  the  medical  and 
health  officials  obtain  from  the  teaching  corps.^  Such  co- 
operation can  never  be  generally  attained  with  this  work 
in  the  hands  of  boards  of  health.     Many  other  facts  in  the 

'  "The  Practical  Necessity  of  School  Clinics,"  an  investigation  of  the  treat- 
ment of  school-children  in  New  York  City,  in  the  Popular  Science  Monthly  for 
May,  1914. 


138  EDUCATIONAL  HYGIENE 

situation  favor  the  school's  administration  of  this  work,  while 
few  favor  board-of-health  control. 

Scientific  Organization  with  Little  Increased  Expense. — 
As  stated  above,  the  expenditure  for  such  a  supervisor  of  hygi- 
ene, in  cities  that  already  are  doing  their  duty  to  the  children  in 
the  Hne  of  health,  with  school  doctors,  nurses,  and  physical- 
training  teachers,  frequently  may  require  little  or  no  addi- 
tion to  the  present  school  budget,  the  work  being  merely 
that  of  reorganization  of  the  various  health  provisions  which 
have,  in  various  ways  and  for  several  years,  been  coming 
into  the  school  systems.  In  all  but  the  largest  cities  the 
director  can  take  the  place  of  one  or  more  part-time  physi- 
cians, and  can  also  do  the  work  of  one  or  more  supervisors, 
or  teachers,  of  physical  training  in  the  elementary  schools. 
Money  can  also  be  saved  as  suggested  by  having  him  direct 
the  summer  playground  work  which  now  costs  a  number  of 
cities  considerable  sums,  the  school  clinic  or  clinics  when 
started,  high  and  elementary  school  athletics,  evening  recre- 
ation, and  a  number  of  other  savings  which  may  go  to  make 
up  his  salary.  The  nurses,  when  so  directed,  may  take  the 
places  of  attendance  officers  in  many  cities,  and  so  save  an- 
other considerable  item. 

The  present  expenditures  in  these  fields  and  the  reorgan- 
ized expenditures  have  been  given  for  twenty-five  cities  in 
"School  Health  Administration."  Most  cities  have  not  yet 
caught  up  with  the  school-health  needs;  but  most  cities  of 
average  size  can  secure  such  departments  of  hygiene  for  little 
over  2/03  per  cent  of  current  school  expenditures.  In  many, 
the  added  expense  will,  as  suggested,  be  inconsiderable. 

For  further  concreteness,  the  old  and  the  new  reorgan- 
ized expenditures,  for  a  fairly  typical  city  already  possessing 
the  elements  of  such  a  department,  are  here  given.  This 
city  has  a  population  of  about  50,000;  there  are  fifteen  schools, 
a  public-school  average  enrolment  of  6,000  pupils;  and  an- 
nual current  expenditures  amounting  to  about  $250,000. 


ADMINISTRATION   OF   EDUCATIONAL   HYGIENE         1 39 


OLD,  UNCORRELATED  SYSTEM 

2  high-school  teachers  of  physical  training $2,200 

2  elementary-school  teachers  of  physical  training 1,800 

6  physicians,  two  one-hour  school  visits  weekly,  at  $300 1,800 

3  school  nurses,  44  hours  a  week,  at  $750,  ten  months 2,250 

Total $8,050 

REORGANIZED,  DIRECTED  SYSTEM 

1  supervisor  of  hygiene,  full  time,  11  months $3,000 

2  high-school  teachers  of  physical  education 2,200 

I  assistant  physician,  two  hours  a  day,  ten  hours  a  week. .  . .  400 

3  school  nurses,  44  hours  a  week,  2  at  $825,  i  at  $750 2,400 

Total $8,000 

Here  we  have  the  new  organized  and  directed  system 
at  less  than  the  original  cost.  There  remain  $50  toward 
more  efficient  records  and  blank  forms.  We  have  deducted 
nothing  for  saved  expenditures  for  attendance  officers,  play- 
ground direction,  etc.,  nothing  but  five  unnecessary  part-time 
physicians  and  the  two  elementary  teachers  of  physical  train- 
ing. Where  the  latter  officials  are  paid  less  in  the  old  system 
and  the  supervisor  $2,500  instead  of  $3,000,  there  is  another 
balancing  of  expenditures.  The  point  is  that  the  added  ex- 
pense need  not  be  great. 

The  third  nurse  may  not  be  added  the  first  year,  which 
would  give  a  further  reduction  of  $750.  Perhaps  scientific 
management  may  make  her  permanently  unnecessary  in 
many  cities.    The  tendency  is,  however,  in  the  other  direction. 

The  supervisor  can,  with  the  daily  help  of  one  of  the 
two  or  three  nurses,  for  two  hours  a  day,  examine  the  same 
number  of  children  as  the  assistant  physician,  3,000;  and 
he  can  call  the  teachers  together  by  grades  and  teach  them 
how  to  carry  on  the  physical-training  work  at  the  schools; 
and  can  take  part  of  each  day  in  supervising  their  work. 

The  assistant  physician  is  paid  $100  more  a  month,  and 


I40  EDUCATIONAL  HYGIENE 

gives  two  full  hours  in  one  school  daily.  With  the  assistance 
of  one  of  the  nurses  he  can  examine  during  the  school  year 
the  other  half  of  the  school  population  (3,000  pupils),  and 
can  help  make  such  inspections  as  are  necessary.  The  third 
nurse,  if  employed,  is  left  free  for  individual  and  classroom 
inspections  and  for  follow-up  work.  Neither  the  teachers 
nor  the  physicians  are  bothered  with  vision  and  hearing  tests, 
the  nurses  making  them;  and  practically  all  clerical  work 
connected  with  medical  supervision  will  also  be  done  by  the 
latter.  The  physicians  will  be  free  for  technical  medical  work, 
and  the  teachers  will  be  less  interrupted. 

Two  of  the  nurses  are  paid  for  an  extra  month  in  the 
summer,  one  for  July  and  one  for  August,  to  follow  up  cases 
not  cured  at  the  end  of  the  school  year  and  for  necessary 
inspection  of  children  at  summer  schools  and  playgrounds. 
Some  of  the  most  valuable  work  now  being  done  by  nurses 
is  accomplished  in  these  summer  months;  and  the  number 
of  skin,  parasitic,  and  infectious  ailments  is  very  much  less 
at  the  opening  of  the  next  school  year. 

The  two  high-school  teachers  of  physical  training,  one  a 
man  and  the  other  a  woman,  are  left  at  perhaps  the  same 
salaries  ($1,300  and  $900). 

The  supervisor  of  hygiene  gives  his  entire  time  to  the 
work,  not  for  ten  but  for  eleven  months.  If  he  obtains  a 
thoroughly  good  assistant  school-physician,  the  salary  of 
the  latter  may  be  raised  from  $400  to  $500  or  more,  but 
not  sufficient  to  make  possible  the  employment  of  another 
nurse  at  the  same  sum  perhaps.  It  may  be  well  to  employ 
a  woman  physician  as  part-time  medical  examiner  so  she  may 
better  examine  the  high-school  girls. 

The  trials  and  tribulations  of  the  superintendent  in  try- 
ing to  get  regular  and  responsible  work  from  part-time 
physicians  and  in  attempting  to  direct  medical  work  without 
medical  knowledge  are  now  at  an  end.  He  has  a  small,  com- 
pact, and  almost  entirely  full-time  force.  These  are  essentials. 
The  entire  part-time  element  may  yet  be  eliminated,  but  it 


ADMINISTRATION   OF   EDUCATIONAL  HYGIENE         I41 

will  mean  salaries  from  $1,500  to  $2,000,  at  least,  for  full- 
time  assistant  physicians. 

Later  developments  of  the  system  can  be  made,  however, 
after  intelligent  study  and  experience.  If  another  physician 
is  desired  he  may  be  obtained,  and  if,  as  the  city  grows,  an 
assistant  in  physical  education  for  the  elementary  schools  is 
found  necessary,  the  addition  can  be  made.  But  these  ad- 
ditions are  intelHgent  choices  by  an  expert  in  educational 
hygiene,  after  reasonable  investigation.  We  attempt  to  give 
here  only  minimum  essentials  and  suggestions  for  beginning 
or  reorganizing  the  work. 

At  the  recent  International  Congress  on  School  Hygiene 
at  Buffalo  the  writer  was  given  practically  the  following  facts 
by  a  member  of  a  board  of  education  of  a  typical  New  Eng- 
land city  (about  9,000  pupils)  with  a  request  for  a  plan  of 
efficient  reorganization: 

PRESENT  "INEFFICIENT"  SYSTEM 

12  part-time  physicians  at  $500 $6,000 

0  nurses 000 

2  truant  oflficers 2,500 

1  elementary  physical-training  teacher 1,000 

I  summer  director  of  playgrounds 150 

Total $9,650 

This  system,  recognized  by  the  board  of  education  as 
inefficient  and  not  getting  results,  is  a  finely  devised  machine 
for  securing  Httle  more  than  a  collection  of  pathological  sta- 
tistics of  school  population.  The  time  the  physicians  spend 
in  the  schools  is  unknown;  and  they  have  no  supervision  nor 
nurses  to  follow  up  cases  and  get  treatments  and  cures.  There 
are  no  pubHc  dispensaries  for  free  treatment  of  children,  and 
a  large  share  of  the  population  is  too  poor  to  pay  $20  for  an 
adenoid  operation,  for  example,  or  to  provide  regular  daily  or 
weekly  treatment  for  favus,  ringworm,  discharging  ears,  and 
other  ailments.     There  is  enough  money  being  spent,  however, 


142  EDUCATIONAL  HYGIENE 

to  get  efficient  results  in  this  field.  Leaving  the  high-school 
directors  of  physical  education  in  their  places  at  the  same 
salaries,  we  have  for  a  beginning  the  following: 

PLAN  OF  REORGANIZATION 

1  supervisor  of  hygiene,  a  physician-physical-educator $2,500 

6  school  nurses,  4  at  $700,  2  at  $770 4,44° 

2  part-time  physicians,  two  hours  daily,  at  $500 1,000 

I  school  cUnic,  with  dental,  surgical,  and  medical  divisions. .  1,000 

I  school  dentist,  with  staff  of  voluntary  dentists 500 

New  blank  forms  for  records  and  reports 210 

Total $9,650 

Here  we  have  a  vastly  more  efficient  system  at  the  same 
expenditure  of  money;  we  have  skilled  leadership  and  super- 
vision; we  have  a  plan  which  unifies  all  school-health  agencies; 
and  we  have  the  emphasis  where  it  belongs,  on  prevention 
and  cures.  Necessary  changes  can  be  made  after  adequate 
investigation  by  the  hygiene  supervisor  and  superintendent 
of  schools.  After  the  first  year  the  thousand  dollars  of  the 
budget  spent  for  equipping  the  school  chnic  will  be  available 
as  a  salary  appropriation  for  one  or  two  part-time  physicians. 

For  the  largest  cities,  such  a  health  reorganization  can 
easily  be  made,  and  it  is  practically  possible  for  many  cities 
having  a  population  almost  as  small  as  eight  or  ten  thousand. 
Several  towns  may  even  go  together  and  employ  such  an  expert, 
as  superintendents  are  now  employed  in  several  States.  And 
even  rural  districts  may  unite  in  the  same  way  for  the  expert 
services  of  an  educational  hygienist  and  several  nurses.^  The 
great  need  is  for  health  experts  and  for  health  leadership. 
The  people  will  respond  and  act  along  the  best  health  lines 
when  the  health  knowledge,  now  the  possession  of  the  few, 
is  made  the  possession  of  the  many.  We  have  suggested  here 
a  possible  channel   for  such  general  health  enlightenment. 

'  See  the  writer's  survey  of  rural  school  hygiene  in  Pennsylvania  as  given  in 
the  1Q14  "Rural  School  Report"  to  the  Pennsylvania  State  Educational  Asso- 
ciation. 


ADMINISTRATION   OF   EDUCATIONAL  HYGIENE         1 43 

The  far-reaching  influence  of  such  school-health  leadership 
on  national  health  and  vitaHty  can  as  yet  hardly  be  imagined. 

Other  Plans  for  the  School  Medical  Service. — Disregard- 
ing as  ineffective  the  physician-alone  plan  for  school-medical 
work,  we  have  two  principal  alternatives  for  serious  considera- 
tion: the  physician-and-nurse  plan,  already  suggested,  and 
the  nurse-alone  plan.  For  both  there  is  the  need  of  a  super- 
vising director  of  hygiene,  unless  the  superintendent  of  a 
small  city  is  exceptionally  well  qualified  medically  and  has 
time  to  devote  to  the  work.  We  need  supervisors  of  hygiene 
as  much  or  more  than  we  need  supervisors  of  music,  drawing, 
and  such  subjects.  For  both  plans  we  may  have  either  phys- 
ical examinations  with  inspection  or  only  inspection  alone.  We 
shall  take  the  stand  that  routine  examinations,  annually,  are 
important  as  well  as  inspections.  In  the  nurse-alone  plan  the 
routine  inspections,  with  the  use  of  individual  cumulative 
health-record  cards,  can,  at  first,  take  the  place  of  complete 
medical  examinations,  by  simply  adding  the  vision  and  hear- 
ing tests. 

The  nurse-alone  plan  is,  in  general,  far  superior  to  the 
physician-alone  plan,  for  a  number  of  reasons,  chief  of  which 
is  that  the  former  gets  treatment  and  cure  for  a  large  per- 
centage of  the  cases,  while  the  latter  procures  treatment  and 
cure  for  but  5  or  6  to  20  per  cent  of  the  cases.  Furthermore, 
the  nurses  can  find  most  of  the  cases  of  all  kinds,  and  can 
inspect  satisfactorily,  as  proved  in  New  York,  for  infectious 
diseases,  especially  when  under  supervision  (September,  1911, 
Report  of  Bureau  of  Municipal  Research).  Cities  as  small  as 
Canton,  Mass.,  with  less  than  5,000  population,  and  as  large 
as  Oakland,  Cal.,  with  nearly  200,000,  get  good  work  with 
only  nurses,  under  supervision.  (Reports  and  letters  of  Doctor 
Arthur  T.  Cabot  and  of  Doctor  N.  K.  Foster,  respectively.) 

Newark,  with  thirty-eight  doctors  and  eight  nurses,  has 
reversed  these  figures  by  exchanging  two  doctors  for  each 
added  nurse.  Only  five  or  six  doctors  were  kept  as  dis- 
trict supervisors  of  the  nurses.     With  the  general  supervisor 


144  EDUCATIONAL  HYGIENE 

as  before,  tliis  has  already  greatly  increased  the  efficiency 
for  the  money  expended.  Further,  physicians  can  work  but 
part  time,  while  nurses  devote  their  entire  time  to  the  work. 
The  physicians  are  irregular  and  difficult  to  control  in  large 
numbers,  while  nurses,  with  practically  no  serious  competing 
interests,  are  easily  directed.  And,  finally,  they  are  less  than 
half,  and  frequently  only  one-fifth,  as  costly,  hour  for  hour,  and 
for  the  year,  as  physicians.  The  tables  given  in  the  writer's 
volume  previously  mentioned  show  even  greater  dispropor- 
tions of  cost  in  a  number  of  cities,  when  the  annual  number  of 
daily  visits,  and  number  of  hours  each,  are  taken  into  con- 
sideration. Good,  regular  physicians,  furthermore,  can  spare 
Uttle  more  than  two  hours  a  day  regularly  and  punctually 
from  their  practise;  and  physicians  for  longer  periods  must  be 
paid  too  much  and  cannot  well  stand  the  strain  and  monotony 
of  long-continued  examination  or  inspection.  Diminishing 
returns,  with  the  larger  salaries  for  full-time  physicians,  bring 
in  the  school  nurse  often  much  more  efficient  hour  for  hour 
than  such  physicians  as  can  be  obtained.  That  the  nurses 
need  training,  before  and  while  in  service,  and  that  they 
must  have  competent  supervision,  is  immediately  apparent. 
The  plan  here  outhned,  however,  places  the  emphasis  upon 
the  nurse  and  the  physician,  the  physician-nurse  plan.  Get- 
ting full-time  work  from  all  school-health  officials,  a  great 
desideratum,  remains  a  nice  problem  for  careful  study  and 
local  adjustment.  The  first  thing  is  to  get  the  hygiene  super- 
visor, next  the  nurses,  and,  finally,  part  or  full  time  physicians. 
A  very  small  city  unable  to  obtain,  with  others  even,  a  super- 
visor should  start  if  possible  with  a  nurse  rather  than  with 
part-time  physicians.  If  only  a  physician  is  employed  the 
principal  and  teachers  must  do  the  follow-up  work.  In  either 
case  the  record  and  report  forms  given  in  a  later  chapter 
may  be  used. 

Where  to  Obtain  School  Nurses. — As  with  all  other 
forms  of  public  service,  the  success  of  medical  and  health 
work  depends  very  largely  upon  the  character  of  the  persons 


ADMINISTRATION   OF   EDUCATIONAL  HYGIENE         1 45 

chosen  to  carry  it  on.  The  greatest  weakness  of  our  school 
systems  at  the  present  time  is  due  to  the  fact  that  our  teachers 
are  quite  generally  young  women  novices  with  a  teaching 
tenure  of  three  to  five  years  only,  and  very  largely  ignorant 
of,  and  inexperienced  in,  the  real  Ufe  of  the  community  and 
nation  about  them.  Educational  readjustment  must  wait 
upon  the  improvement  of  the  character  of  the  teaching  force. 
With  even  the  best  of  supervision  and  the  most  scientific 
plans  of  management  the  health  service,  likewise,  can  remain 
palsied,  feeble,  and  inefficient. 

After  deciding  to  obtain  officials  for  the  school-health 
work,  therefore,  the  practical  problem  becomes  one  of  ob- 
taining high-class  health  agents.  For  nurses,  we  must  as 
yet  depend  very  largely  upon  the  various  training  schools 
for  visiting  nurses,  and  the  visiting  nurses'  associations. 
The  Department  of  Nursing  and  Health,  under  the  direction 
of  Miss  M,  A.  Nutting,  R.N.,  at  Teachers  College,  Columbia 
University,  in  New  York  City,  is  at  present  the  only  insti- 
tution in  the  country  which  gives  special  instruction  and 
training  for  school  nurses,  and  the  number  who  can  be  sup- 
plied is  at  present  very  small.  This  is  the  first  source  I  should 
recommend. 

Miss  E.  P.  Crandall,  R.N.,  Executive  Secretary  of  the 
National  Organization  for  PubHc  Health  Nursing,  52  East 
Thirty-fourth  Street,  New  York  City,  and  Miss  E.  L.  Foley, 
R.N.,  Superintendent  of  the  Visiting  Nurse  Association,  104 
South  Michigan  Avenue,  Chicago,  may  also  be  depended 
upon  to  advise  school  systems  of  graduate  nurses  who  are 
specially  quahfied  for  and  looking  toward  public-school  work. 
Miss  Fannie  F.  Clement,  713  Union  Trust  Building,  Wash- 
ington, D.  C,  can  give  valuable  information  regarding  the 
Red  Cross  Rural  Nursing  Service  and  persons  available  as 
school  nurses.  The  Boston  District  Nurses  Association  in 
afiiHation  with  the  Boston  School  for  Social  Workers,  as  well 
as  the  Cleveland  Visiting  Nurses  Association  in  affiliation 
with  Western  Reserve  University,  and,  finally,  Phipps  In- 


146  EDUCATIONAL   HYGIENE 

stitute  of  Philadelphia  are  also  in  touch  with  most  nurses  in 
the  country. 

The  editor  will  be  pleased  to  send  the  names  of  any 
persons  known  to  be  qualified  either  as  hygiene  supervisors 
or  as  school  nurses  to  responsible  persons,  without  charge  to 
either  party.  Like  Albany,  N.  Y.,  a  city  may  find  in  its  midst 
a  man  qualified  both  as  a  physician  and  a  physical  educator 
for  such  work,  and  good  nurses  amenable  to  training  in  the 
school  service. 

The  Future. — It  is  not  to  be  expected,  of  course,  that  this 
plan  is  a  cure-all.  It  is  based  on  the  actual  conditions  and 
needs  of  schools  and  does  not  represent  anything  impossible 
in  the  way  of  money.  In  this  country  and  abroad  cities  and 
states  are  actually  adopting  it  with  sHght  variations,  and 
we  believe  it  is  scientific  and  along  the  right  lines  for  the  best 
future  growth.  The  recommendation  of  a  skilled  supervisor  of 
hygiene  in  each  school  system  or  group  of  schools  is  the  best 
guarantee  of  study,  growth,  adaptation,  and  improvement. 

The  plan  as  extended  to  medical  supervision  I  give  in  a 
later  chapter.  The  State's  responsibility  and  opportunity 
for  school  health  administration  and  extension  will  next  be 
taken  up. 


CHAPTER  rX 

A  PLAN  OF  STATE   CO-OPERATION   FOR   SCHOOL- 
HEALTH   PROGRESS 

Importance  of  Co-operation  in  School-Health  Adminis- 
tration.— The  co-operative  commonwealth  has  been  the  dream 
of  many  a  philosophical  imagination.  No  one  dream  has 
ever  come  true  in  detail.  But  that  co-operation  is  a  funda- 
mental necessity  in  community  life  is  becoming  more  and 
more  evident  with  the  increasing  variety  and  complexity  of 
human  relations.  This  co-operation  is  desirable  and  neces- 
sary not  only  to  conduct  successfully  business,  social,  and 
political  affairs,  but  it  is  yet  more  necessary  to  ward  off  and 
to  correct  the  ills  of  the  community,  both  the  present  ills  and 
those  that  threaten. 

Differing  points  of  view  on  matters  of  vital  importance, 
due  in  the  main  to  differing  habits  of  thought  and  of  action 
and  to  unequal  distribution  of  knowledge,  are  largely  respon- 
sible for  those  conditions  in  community  life  that  are  dangerous. 
An  extremely  unequal  distribution  of  wealth  is  harmful  and 
often  dangerous;  but  the  condition  of  ignorance  regarding 
the  fundamental  facts  that  may  be  known  in  matters  per- 
taining to  health  and  industry  creates  situations  that  menace 
community  prosperity.  For  from  such  ignorance  result  un- 
hygienic and  wasteful  habits  of  life  and  serious,  antagonistic 
prejudices. 

Education  and  Health.— Education,  i.  e.,  the  process  of  in- 
forming and  training  in  right  practises,  appears  to  be  the  sole 
force  by  which  those  community  conditions  that  menace 
health  and  prosperity  may  be  bettered.     In  the  evolution  of 

147 


I4S  EDUCATIONAL  HYGIENE 

the  general  educational  programme  every  important  commu- 
nity activity  is  involved,  and  it  requires  for  its  carrying  out  the 
employment  of  national  and  State  as  well  as  local  agencies 
and  resources.    Particularly  is  this  true  of  education  in  hygiene. 

Responsibility  of  State  Departments  of  Education  for 
Public  Health.— It  is  not  the  purpose  of  this  chapter  to  dis- 
cuss national  and  State  legislation  and  administration  of 
health  agencies,  but  to  call  attention  to  the  fact  that  a  State 
department  of  education  must  accept  in  any  general  educa- 
tional programme  a  larger  responsibility  than  it  has  assumed 
in  the  past,  viz.,  the  responsibility  for  systematically  promot- 
ing educational  propaganda  among  the  adult,  non-school- 
attending  part  of  the  population.  With  this  responsibility 
it  must  also  assume  the  task  of  securing  general  approval 
and  support  in  the  State  for  those  educational  measures  that 
it  is  desirable  to  introduce  into  the  schools. 

Lectures  and  widely  circulated  printed  bulletins  have  been 
the  principal  means  employed  by  the  State  in  the  past  for 
disseminating  information.  More  recently  specific  training 
has  been  offered  by  the  State  in  a  desultory  sort  of  way  to 
adult  citizens,  in  agriculture  and  other  industries.  But  the 
numerous  voluntary  organizations  now  found  in  every  State 
may  become  powerful  allies  in  any  proper  educational  move- 
ment. 

The  State's  Share  of  Responsibility. — Some  part  the 
State  must  take  in  the  affairs  of  each  community,  but  in  a 
democracy  it  would  appear: 

First. — -That  the  State  should  take  over  completely  only 
those  responsibilities  that  by  their  nature  cannot  be  shared 
successfully  with  local  authorities. 

Second. — That  it  should  become  a  partner  in  those  re- 
sponsibiUties  only  which  by  their  nature  are  partly  extra- 
local. 

Third. — That  it  should  not  regulate  any  local  activities 
except  those  upon  which  the  prosperity  of  the  State  depends, 
and  these  only  when  local  regulation  has  proved  ineffective. 


STATE   CO-OPERATION  1 49 

Fourth. — That  so  far  as  possible  the  State  should  express 
itself  by  the  avenues  of  advice,  inspiration,  and  information 
rather  than  by  dictation  and  compulsion. 

The  individuahty  of  a  locality  must  be  preserved,  its  in- 
telUgence  must  be  promoted,  its  initiative  must  be  strength- 
ened, its  conscience  must  be  kept  ahve,  its  citizenship  must 
be  trained,  because  the  "locality"  is  the  training-ground  for 
whatever  citizenship  is  in  the  State. 

If  the  State  is  to  succeed  by  democratic  rather  than  by 
autocratic  means,  its  measures  and  proposals  must  have  the 
approval  of  "pubUc  sentiment."  To  secure  this  approval 
and  to  transform  it  from  a  passive  to  an  active  force,  it  would 
appear  that  the  State  must  be  in  close  co-operative  relation 
with  those  factors  in  the  State  that  are  intelHgent  and  pow- 
erful enough  to  create  a  favorable  "public  sentiment"  and 
aggressively  to  support  a  given  poHcy  in  each  locaHty. 

Getting  Health  Agencies  to  Work  Together  for  a  Conimon 
Purpose. — These  considerations  were  forced  upon  our  atten- 
tion when  the  commissioner  of  education  decided  to  formu- 
late a  comprehensive  plan  of  instruction  and  training  in  hygiene 
for  the  schools  of  New  Jersey.  It  was  evident  that  any  such 
plan  to  be  effective  in  the  schools  must  comprehend  the 
adrdt  population,  also,  since  knowledge,  conviction,  and  prac- 
tise in  matters  pertaining  to  hygiene  were  lacking  in  many 
localities.  Moreover,  inasmuch  as  the  plan  of  school  in- 
struction was  based  on  the  idea  that  instruction  was  to  find 
an  immediate  application  not  only  in  the  school  Ufe  but  also 
in  the  home  and  community  life,  there  was  danger  that  passive 
popular  indifference  might  become  active  antagonism  unless 
the  community  became  partners  in  carrying  out  the  plan. 

A  tabulation  of  the  agencies  in  the  State  whose  co-opera- 
tion the  department  of  pubKc  instruction  might  secure 
showed  the  following: 


150  EDUCATIONAL  HYGIENE 

AGENCIES  AVAILABLE  IN  THE  STATE  FOR  PURPOSES  OF 
EDUCATION  IN  HYGIENE 

I.    State  Agencies  for  Education 

1.  State  Board  of  Education. 

2.  Department  of  Public  Instruction. 

Commissioner  of  Education. 
Assistant  Commissioners. 
State  Inspector  of  School  Buildings. 
County  Superintendents. 

3.  State  Normal  Schools. 

4.  State  Summer  Schools. 

5.  Extension  Normal-School  Courses. 

II.    Local  School  Agencies 

1.  Boards  of  Education. 

2.  City  Superintendents. 

3.  School  Supervisors  and  Principals, 

4.  Directors  of  Physical  Education. 

5.  Teachers. 

6.  School  Medical  Inspectors  and  Nurses. 

III.    Agencies  in  the  State  Interested  in  the  Provision 
OF  Health 

1.  State  Board  of  Health. 

Lecturer  on  Hygiene. 
Lecturer  on  Tuberculosis. 

2.  State  Medical  Society. 

3.  State  Sanitary  Association. 

4.  State  Dental  Association. 

5.  State  Board  of  Architects. 

6.  Commissioners  of  Charities  and  Correction. 

7.  State  Grange. 

8.  Local  Boards  of  Health. 

9.  New  Jersey  Congress  of  Mothers. 

10.  Woman's  Christian  Temperance  Union. 

11.  New  Jersey  State  Federation  of  Women's  Clubs. 

12.  New  Jersey  Sons  of  Temperance. 

13.  United  Friends'  Order  of  American  Mechanics. 

14.  Patriotic  Order  Sons  of  America. 

15.  Local  Playground  Associations. 


STATE   CO-OPERATION  151 

16.  Local  Civic  Organizations. 

17.  State  Agricultural  Experiment  Station. 

18.  Princeton  University — Department  of  Hygiene. 

19.  Rutgers  College — Department  of  Education. 

More  than  half  of  these  agencies  have  assisted  in  working 
out  the  details  of  the  plan  of  educational  hygiene  for  the 
schools.  These  agencies  are  influential  in  the  State  as  a  whole 
and  their  members  are  scattered  throughout  the  State. 

It  has,  therefore,  already  been  practically  proved  that 
the  State  has  a  most  valuable  asset  in  its  civic  organizations, 
an  asset  that  should  not  be  ignored  in  any  programme  of 
education  involving  interests  which  they  and  the  State  edu- 
cational authorities  have  in  common. 

Health  Education  of  Adults. — But  the  general  plan  of 
education  in  hygiene  will  be  only  partially  carried  out  when 
the  programme  of  work  for  the  schools  has  been  completed 
and  distributed,  and  is  operative  in  the  schools  with  the 
general  approval  of  the  local  communities.  As  before  sug- 
gested, the  time  has  come  for  the  State  department  of  edu- 
cation to  assume  responsibihties  for  the  systematic  education 
of  those  not  connected  with  the  schools,  who  cannot  be 
reached  directly  through  them.  The  theory  that  the  habits 
of  thought  and  conduct  of  adults  cannot  be  affected  by  edu- 
cation is  not  soimd.  Opportunities  are  being  offered  to  adults 
in  many  States  to  learn  more  about  their  own  trade,  or  to 
learn  a  new  one.  These  vocational  school  courses  are  super- 
vised and  wholly  or  in  part  financed  by  the  State. 

There  would  seem  to  be  no  escape  from  the  conclusion 
that,  inasmuch  as  health  is  more  fundamental  than  industry. 
the  State  must  assume  responsibility  for  the  maintenance  of 
the  public  health  on  as  high  a  plane  as  it  can  be  maintained. 
It  is  not  enough  to  have  officers  going  about  enforcing  pure- 
food  laws  and  laws  for  the  protection  of  water  sources.  The 
rapidly  accumulating  body  of  knowledge  regarding  matters 
of  health  in  all  its  phases  must  be  brought  to  the  people  in 
such  a  way  that  they  will  become  inteUigent  partners  with 


1^2  EDUCATIONAL   HYGIENE 

the  State  in  maintaining  their  own  health  and  improving  it 
on  their  own  initiative. 

This  hygienic  intelHgence,  hygienic  conscience,  and  hy- 
gienic practise  can  be  promoted  only  by  the  process  of  edu- 
cation; a  process  of  education  that  is  operative  not  only  in 
the  schools,  but  continuously  and  systematically  among  the 
adults  who  do  not  attend  school. 

The  responsibiUty  for  the  formulation  and  carrying  out  of 
this  twofold  or  two-sided  plan  of  education  in  hygiene  can 
rest  nowhere  but  in  a  State  department  of  public  education. 

State  Supervisor  of  Educational  Hygiene. — To  carry  out 
any  such  plan  there  should  be  a  State  supervisor  of  educational 
hygiene.  This  supervisor  should  have  had  training  and  ex- 
perience as  a  physician  and  as  a  teacher.  He  should  be  com- 
petent in  the  fields  of  medical  supervision,  school  sanitation, 
physical  education,  the  teaching  of  hygiene,  and  the  hygiene 
of  methods  of  instruction.  He  should  also  be  a  student  of 
sociology,  and  should  be  able  to  stimulate,  guide,  and  help 
make  efficient  all  phases  of  school  hygiene  and  the  general 
education  in  hygiene.  In  brief,  the  health  of  the  State  is  so 
fundamentally  important  that  the  maintenance  of  it  must  be 
assumed  by  the  State.  Education  in  matters  of  health  is 
the  only  means  of  making  hygienic  practises  prevail  in 
the  life  of  each  citizen.  This  education  must  affect  the  life 
of  the  adult  as  well  as  of  the  young  citizen  in  school.  Any 
general  programme  of  education  in  hygiene  will  require  in 
its  formulation  and  for  its  effective  working  the  co-operation 
of  other  State  departments  interested  in  matters  of  health 
and  of  all  available  civic  forces  focussed  in  organizations 
throughout  the  State.  The  bigness  and  the  importance  of 
the  problem  require  that  its  solution  be  placed  in  the  hands 
of  a  supervisor  of  educational  hygiene.  One  of  the  prime 
functions  of  such  a  supervisor  is  to  secure  this  active,  guided 
co-operation  to  the  end  that  hygienic  intelHgence,  convic- 
tion, and  practises  may  be  promoted  in  every  community  in 
the  State. 


CHAPTER  X 
CITY  SCHOOL-HEALTH  ADMINISTRATION 

School-Health  Departments. — The  educational  progress 
of  the  future  is  conditioned  to  a  large  degree  by  the  right 
solution  of  the  problems  of  educational  hygiene.  Educational 
hygiene  is  therefore  vital  in  education.  Its  scope  is  broad. 
Its  organization  is  varied  and  requires  skill  and  ability  of 
high  order.  It  has  been  developed  and  exists  at  present  in 
cities  under  the  different  captions:  School-Health  Depart- 
ment, Department  of  Hygiene,  Department  of  Health  and 
Development,  Medical  and  Dental  Inspection  of  Schools, 
Department  of  Child  Study  and  Educational  Research,  De- 
partment of  Psychology,  etc.  These  departments  are  at 
present  under  the  control  of  boards  of  health,  of  boards  of 
education,  or  of  both  boards  acting  jointly.  It  is  the  purpose 
of  this  chapter  to  discuss  the  scope  and  purpose  of  the  entire 
field  of  work  as  at  present  administered,  in  part  or  as  a  whole, 
under  the  above  captions  and  to  suggest  future  development 
and  organization. 

The  development  of  this  science  and  practise  in  its  best 
expression  at  present  is  as  follows: 

(i)  Adequate  medical  inspection  of  schools  by  medical 
experts  for  the  detection  of  and  prevention  of  infectious  dis- 
eases. 

(2)  The  co-operation  of  medical  experts  with  city,  county, 
and  State  officials  in  the  problems  of  pubUc  health. 

(3)  Sanitary  inspection  of  school  buildings  and  grounds. 
This  is  the  older  form  of  medical  inspection  of  schools. 

It  is  well  established  in  the  leading  cities  of  the  United  States. 
There  are,  however,  even  at  present,  instances  of  extremely 

153 


154  EDUCATIONAL  HYGIENE 

poor  administration  of  this  absolutely  essential  field  of  work 
from  the  standpoint  of  pubhc  health.  This  statement  is 
especially  true  of  the  sanitary  inspection  of  school  buildings 
and  grounds.    To  this  must  be  added: 

(4)  That  part  of  the  field  of  work  essential  for  the  more 
intelligent  handling  of  pupils  and  students  throughout  their 
period  of  educational  training. 

(5)  Thorough  examination  for  physical  defects. 

(6)  The  maintenance  of  hygienic  activity,  and  hygiene 
of  instruction. 

(7)  Adequate  teaching  of  hygiene. 

(8)  Correction  and  cure  of  ailments  found. 

These  various  phases  are  comprehended  by  the  fivefold 
discussion  of  the  subject  in  this  volume. 

Purposes  of  the  Work. — ^(i)  The  estabHshment  of  bien- 
nial, annual,  and,  when  advisable  or  necessary,  more  frequent 
skilled  physical  and  developmental  examinations  of  pupils 
by  a  staff  of  experts. 

(2)  The  establishment  of  psychological  examination  of 
pupils  and  students  by  a  staff  of  psychological  experts,  to  make 
reliable  tests  of  the  mental  traits  and  capacities  of  pupils  at 
such  times  as  may  be  necessary  for  more  accurate  knowledge 
of  mental  development,  for  more  inteUigent  classification, 
gradation,  and  educational  training  of  pupils. 

(3)  By  effective  action  based  upon  the  data  of  skilled 
physical  and  psychological  examinations  to  secure:  (a)  The 
correction  of  physical  defects  and  other  defective  develop- 
ment and  thus  remove  the  growth  barriers  of  children  and 
youths,  {b)  To  maintain  a  scientific  and  systematic  investi- 
gation of  mental  retardation  and  of  mental  and  moral  devia- 
tion of  pupils  in  the  pubhc  schools,  (c)  Through  the  agency 
of  skilled  examination  to  provide  school  authorities  with  in- 
formation essential  for  the  better  adjustment  of  educational 
training  to  the  requirements  of  physical  and  mental  health, 
growth,  and  development  of  pupils,  (d)  To  bring  about  the 
estabHshment  of  medical  and  dental  clinics,  and  to  provide 


CITY   SCHOOL-HEALTH  ADMINISTRATION  1 55 

medical  and  dental  aid  for  pupils  whose  parents  are  financially 
unable  to  provide  such  aid. 

(4)  The  establishment  of  skilled  physical  and  health 
examination  and  skilled  psychological  examination  of  candi- 
dates for  teachers''  positions  prior  to  their  election  to  determine 
fitness  for  work  and  thereafter  to  maintain  health  and  efl&- 
ciency  supervision  of  teachers  as  related  to  the  work  of  the 
schools. 

(5)  {a)  To  provide  courses  of  technical  instruction  in  hy- 
giene and  related  subjects  for  pupils  and  students,  in  the  means 
of  conservation  of  physical  and  mental  health,  growth,  and 
development,  and  in  the  means  of  correction  and  prevention 
of  defects,  disease,  and  degeneracy.  (6)  As  far  as  may  be 
advisable,  to  give  technical  and  practical  instruction  to  the 
teaching  force  of  the  schools  in  the  initial  physical,  psycho- 
logical, and  developmental  examinations  of  pupils  normal, 
subnormal,  and  supernormal,  and  to  organize  such  initial 
examinations  and  surveys  of  pupils  by  the  teaching  force  of 
the  schools  under  the  direction  of  experts. 

(6)  To  establish  and  maintain  well-equipped  medical, 
anthropometric,  and  psychological  laboratories  in  the  public 
schools  which  will  '  afford  opportunity  and  equipment  ^ 
{a)  for  sufficiently  skilful  medical,  anthropometric,  and  psy- 
chological examination  of  exceptional  pupils  and  of  all  pupils 
requiring  examination;  {h)  for  the  technical  training  of 
teachers  in  the  laboratory  and  experimental  phases  of  edu- 
cational hygiene. 

(7)  To  provide  an  emergency  service  to  supply  skilled 
medical  aid  to  the  injured  in  the  schools. 

(8)  To  exercise  expert  sanitary  supervision  in  the  plan- 
ning, construction,  and  maintenance  of  school  buildings  and 
grounds.^ 

>  Similar  perhaps  to  the  excellent  College  of  Hygiene  at  Dunfermline,  Scot- 
land. 

'  See  the  Springfield  Survey  of  the  Sage  Foundation  for  evidence  of  the  need 
of  this  provision. 


156  EDUCATIONAL  HYGIENE  ~   - 

(9)  To  so  arrange  this  field  of  work  that  each  department 
of  educational  hygiene  shall  constitute  a  bureau  of  practical 
investigation  and  research,  and  as  such  to  co-operate  with 
State  bureaus  of  educational  hygiene  for  the  organization 
and  supervision  of  State- wide  work  and  investigation  in  this 
special  field  of  education. 

Skilled  Physical  and  Developmental  Examinations  by 
A  Staff  of  Experts — A  General  Plan 

Biennial  Developmental  Examinations — Approximate  Oc- 
currence, ^cj. 

Upon  entering  school 6 

Prior  to  transition  period 8 

Subsequent  to  transition  period 10 

Prepubertal  period 12 

Pubertal  period 14 

Postpubertal  period 16 

Approximate  attainment  of  physical  growth 18 

Biermial,  Annual,   and    More  Frequent  Examinations. — 

Groups  of  pupils  will  stand  out  for  which  thoroughgoing 
biennial  examinations  are  probably  sufficient.  Other  groups 
will  stand  out  which  require  annual  or  more  frequent  exam- 
ination. Examination  for  all  pupils  should  occur  sufficiently 
often  to  maintain  efficient  health,  growth,  and  activity;  super- 
vision— biennial,  annual,  monthly,  or  daily — in  accordance 
with  the  needs  of  pupils.  An  annual  examination  with  fre- 
quent inspections  will  probably  be  found  most  practical  and 
efficient  where  the  staff  is  large  enough. 

GENERAL  ILLUSTRATION  OF  AN  ESSENTIAL  PHYSICAL 
AND  developmental  EXAMINATION  1 

(by  a  staff  of  experts  and  trained  assistants) 

General  health  and  growth,  past  and  present.     Family  history  (ex- 
ceptional pupils),  height,  weight,  and  vitality. 

'  Following  the  report  form  given  in  another  chapter. 


CITY   SCHOOL-HEALTH  ADMINISTRATION  1 57 

Eyesight. — Visual  acuity,  approximate  determination  of  hyperopia, 
hyperopic  astigmatism,  myopia,  myopic  astigmatism,  esophoria, 
exophoria,  hyperphoria,  infectious  eye  defects,  other  diseased  con- 
ditions, and  exceptional  features.  Color-blindness  (exceptional 
pupils). 

Hearing. — Auditory  acuity.  Defective  hearing  due  to  middle-ear 
defects  or  to  nerve  deafness.  Diseased  conditions,  exceptional 
features.     Pitch  discrimination. 

Teeth. — General  conditions  and  cleanliness  of  temporary  and  perma- 
nent teeth,  amount  of  decay,  exceptional  features.  Examination 
of  teeth  to  be  conducted  by  skilled  dentists  whenever  possible, 
except  that  teachers,  nurses,  and  medical  examiners  may  report 
such  cases  to  school  dental  clinics  for  further  examination,  and 
treatment  if  necessary. 

Mouth  and  Palate. — Malformation  and  indications  of  degeneracy. 

Speech. — Defects  of  articulation,  lisping,  stammering,  etc. 

Nose  and  Throat. — Presence  or  absence  of  nasal  obstruction,  diseased 
or  enlarged  tonsils,  presence  of  adenoids,  polypi,  catarrh,  etc., 
and  any  exceptional  features. 

Glandular  Conditions. — Enlarged  submaxillary  or  cervical  glands. 

Lmig  Action  and  Respiratory  Development. — Normal,  rough,  or  bron- 
chial breathing.  Rales — mucous,  sibilant,  sonorous,  pleuritic. 
Chest  development  and  expansion  (tuberculosis,  tendencies  to 
same).    Respiratory  development.    Exceptional  features. 

Heart  Action. — Normal,  irregular.  Murmurs,  functional  or  organic. 
(Transition  period  8  to  10.)  Any  abnormal  condition  requiring 
modification  of  school  conditions  or  exercises.  Thorough  exami- 
nation conditioning  physical  training. 

Deformity. — Deformities  of  head,  trunk,  limbs,  spinal  curvature,  bone 
disease,  deformed  chest,  shortened  limbs,  etc. 

Nervous  System. — ^Normal.  Nervous  instability,  incipient,  marked. 
Neurasthenic  or  hysterical  tendencies.  Chorea,  tics,  epilepsy, 
signs  of  overstrain,  fatigue,  etc. 

Sex  Examinations. — Thorough  sex  examinations  when  advisable. 
Parents  should  be  present. 

Anthropometric  Measurements  and  Strength  Tests. — Essential  for  de- 
velopmental and  corrective  physical  training  and  for  accurate 
knowledge  of  growth.  (These  can  be  made  of  value  where  there 
is  a  skilled  supervisor  of  hygiene  to  use  them.  Usually  they  take 
much  time  but  are  not  utilized.) 

General. — -Any  weakness,  defect,  or  disease  specially  unfitting  pupils 
and  students  for  ordinary  school  life  and  activities,  and  requiring 
modification  of  school  activities. 


158  EDUCATIONAL   HYGIENE 

Physiological  Age — Developmental  Periods. — The  determination  of  the 
physiological  age  of  exceptional  pupils,  subnormal  and  super- 
normal, and  the  adjustment  of  educational  activities  to  growth 
and  development  needs,  especially  at  transition  periods  of  de- 
velopment— 8  to  10  years — and  puberty. 

Application  of  the  Data  of  Skilled  Physical  and  De- 
velopmental Examinations  When  Correlated  with 
THE  Data  of  Psychological  Examinations 

The  Assignment  of  School  Activities. — (i)  General  As- 
signment.— When  taken  in  connection  with  the  order  of  school 
work  outlined  in  the  courses  of  study  and  in  connection  with 
the  sociological  factors  of  the  pupils'  environment,  the  in- 
formation given  by  these  examinations  should  form  a  reliable 
basis  for  the  general  assignment  of  school  activities,  physical 
and  mental,  in  adjustment  to  the  health  and  growth  needs 
and  working  condition  of  pupils,  thus  including  the  field  of 
the  hygiene  of  instruction — of  proper  hygienic  ways  of  han- 
dling and  educating  pupils. 

(2)  Special  Assignment. — The  assignment  of  pupils  to  un- 
graded rooms,  to  special  classes,  and  special  schools  that  have 
been  estabhshed  in  our  larger  cities,  and  the  adjustment  of 
educational  training  in  those  schools,  are  markedly  in  need  of 
a  better  plan  of  procedure.  The  information  given  by  skilled 
physical  and  psychological  examinations,  along  with  socio- 
logical studies  of  home  and  community  environment  of  such 
pupils,  is  essential  to  more  intelligent  assignment  and  adjust- 
ment of  educational  training  of  pupils  in  these  schools  and 
to  the  more  intelligent  issuance  of  work  permits  by  school 
authorities. 

Physical  Education  and  Its  Adjustment  to  Health  and 
Growth  Needs. — (i)  Physical  Training  and  Playground  Ac- 
tivities.— Physical  education  aims  at  the  preservation  of  health 
and  the  development  of  normal  physical  growth,  bodily  re- 
sistance and  vigor,  and,  through  these  values,  an  increased 
capacity  for  mental  and  physical  work.    Developmental  and 


CITY   SCHOOL-HEALTH  ADMINISTRATION  1 59 

corrective  physical  exercises  and  sports  which  supply  activity 
for  the  developing  instincts  are  the  means  to  this  end  in 
physical  training  and  playground  activities.  However,  to  in- 
telligently adjust  such  training  to  the  demands  of  health  and 
to  the  different  levels  of  development  requires  skill  of  high 
order. 

To  this  end  the  physical  director  or  instructor  must  be 
skilled  in  physical  diagnosis,  in  certain  phases  of  medicine, 
and  in  applied  hygiene,  personal  and  developmental.  He 
may  or  may  not  have  had  a  physician's  training,  but  in  either 
case  in  certain  emergency  instances  and  special  cases  he  may 
need  the  advice  and  help  of  a  skilled  practising  physician. 
In  the  past  this  work  has  not  always  been  well  done.  Too 
often  it  has  been  the  case  that  the  physical  instructor  has  not 
had  sufficient  skill  in  diagnosis  nor  sufficient  knowledge  of 
elementary  medicine,  or  physicians  have  attempted  the  work 
who  were  not  experts  in  physical  education.  Developmental 
mass  training  has  been  the  rule  in  physical  education  as  in 
mental  education.  Developmental  and  corrective  individual 
training  has  been  at  a  minimum. 

The  greater  emphasis  that  is  now  being  placed  upon  phys- 
ical activities,  upon  personal  and  developmental  hygiene,  and 
upon  a  higher  order  of  skill,  where  such  is  wanting,  will  plainly 
contribute  to  increased  health  efficiency. 

(2)  Manual  Training  and  Industrial  Work. — Manual 
training  and  industrial  work,  and  physical  training  and  play- 
ground activities,  together  constitute  the  entire  physical-edu- 
cation department  of  the  schools.  Education  has  been  slow  to 
learn  the  lesson  taught  by  the  structure  and  functions  of  the 
motor  area  of  the  brain.  Health  and  developmental  needs 
demand  a  much  larger  amount  of  manual  and  industrial 
training  (motor  training)  than  is  usually  possible  at  present 
in  the  schools,  and  the  adjustment  of  such  training  to  the 
individual  and  to  the  typical  needs  of  pupils.  In  these  re- 
gards educational  hygiene  has  in  the  immediate  future  a  work 
to  do  of  a  very  high  order. 


l6o  EDUCATIONAL  HYGIENE 

Physical  Defects. — Mental  and  Dental  Aid. — The  records 
of  physical  examinations  in  the  United  States  and  in  Europe 
have  shown  that  from  one-half  to  two-thirds  of  all  pupils  in 
the  schools  have  physical  defects  and  ailments,  mostly  re- 
mediable, that  interfere  to  a  greater  or  less  extent  with 
health,  growth,  and  efficiency.  It  is  a  safe  estimate  that  at 
least  one-half  of  these  defects  are  sufficiently  serious  to  need 
special  care,  and  that  it  is  wisdom  to  attend  to  all.  Vital 
efficiency  is  too  valuable  to  waste,  even  to  a  small  extent. 
Moreover,  parents  and  pupils  are  largely  unaware  of  the 
presence  of  these  defective  conditions  or  unaware  of  their 
far-reaching  effects. 

The  result  in  the  schools  is  a  large  amount  of  retarded  or 
arrested  physical  growth  and  poor  vitality;  a  large  amount 
of  mental  retardation  and  inefficiency,  of  degeneracy,  of  more 
or  less  crime;  and  also  a  large  unnecessary  expenditure  of 
public  funds.  Economy  and  efficiency  in  educational  work 
require  effective  action  on  the  part  of  boards  of  education, 
in  co-operation  with  the  parents,  to  remedy  this  life-efficiency 
waste. 

Incipient  Diseases — School  Environment. — Thirty  to  forty 
per  cent  of  all  who  die  between  twenty  and  thirty  years  of 
age  die  of  tuberculosis;  the  curve  of  juvenile  insanity  rises 
rapidly  between  thirteen  and  fifteen  years;  preventable  in- 
cipient nervous  diseases  abound  in  the  schools;  there  is  a 
marked  increase  in  the  death-rate  of  girls  at  about  the  age 
of  eighteen,  due  both  to  incipient  and  slow-acting  diseases; 
more  than  one-half  of  all  the  children  born  in  the  world  die 
before  the  age  of  twenty- three;  and  there  can  be  no  doubt 
that  too  much  of  this  enormous  loss  of  human  life  is  due  to 
unwholesome  conditions  in  the  schools  and  to  lack  of  skilled 
school  care. 

Follow-up  Service,  Getting  Results. — To  inaugurate  a 
plan  of  action  which  will  secure  the  co-operation  of  parents 
and  school  authorities  so  that  pupils  will  secure  the  needed 
medical,  surgical,  or  dental  aid  is  a  work  requiring  skill,  tact, 
and  educational  ability  of  high  order. 


CITY   SCHOOL-HEALTH  ADMINISTRATION  l6l 

Parents  must  be  notified  of  the  results  of  expert  examina- 
tions. In  many  instances  the  consent  of  parents  to  the  ex- 
amination itself  must  first  be  secured.  Those  conducting  the 
work  must  possess  sufficient  tact  and  abihty  to  command  the 
highest  respect  of  parents  and  school  authorities  in  this  field 
of  work,  and  to  secure  the  co-operation  of  physicians  and 
dentists  from  the  standpoint  of  education. 

An  educational  plan  of  action  must  be  persistently  carried 
forward  until  results  for  which  the  work  was  inaugurated 
follow.  Mandatory  State  laws  are  found  in  certain  States, 
but  until  the  work  is  well  estabhshed  mandatory  means  will 
meet  with  much  opposition.  Mandatory  laws  are  not  ad- 
visable until  educational  pubhcity  work  has  brought  about 
the  right  attitude,  and  has  secured  the  co-operation  of  a 
large  majority  of  parents  and  teachers.  We  must  recognize 
that  large  numbers  of  people  yet  interpret  the  efforts  of  school 
authorities  in  securing  the  correction  of  physical  defects  and 
in  providing  other  essential  medical  or  dental  aid  as  a  move 
in  the  interest  of  the  practise  of  medicine  and  dentistry  in- 
stead of  the  practise  of  education.  Permissive  laws  coupled 
with  skilful  educational  work,  patience,  and  persistence  will 
usually  succeed. 

School  Nurses. — The  service  of  the  trained  school  nurse 
in  education  is  one  of  the  main  factors  in  making  health  in- 
spection effective.  The  work  of  the  school  nurse  is  essentially 
as  follows: 

(i)  To  assist  experts  in  skilled  examination  of  pupils 
and  teachers  and  to  notify  parents  of  the  results  of  examina- 
tions. 

(2)  To  assist  teachers  in  making  preHminary  health  and 
growth  surveys  and  initial  examinations  or  inspections  of 
pupils. 

(3)  To  visit  parents  and  discuss  with  them  the  health 
and  growth  needs  of  their  children,  to  secure  remedial  action 
where  necessary,  and  to  give  parents  information  of  the  na- 
ture and  extent  of  the  examinations  and  the  purpose  of  the 
work,  thus  avoiding  opposition  and  securing  co-operation. 


1 62  EDUCATIONAL  HYGIENE 

(4)  To  furnish  efficient  aid  in  emergencies;  to  supply 
efficient  skilled  service  at  school  and  other  clinics;  to  attend 
to  minor  ailmentg'  in  the  schools;  to  teach  practical  hygiene 
to  pupils,  teachers,  and  parents. 

(5)  To  share  largely  in  the  inspection  of  pupils,  and  fre- 
quently to  make  the  vision  and  hearing  examinations. 

Co-operative  Educational  Work. — The  Staff  of  Experts. — 
The  teaching  force  of  the  schools  and  school  nurses,  working 
from  the  standpoint  of  education  in  their  special  field,  form 
an  educational  corps  to  bring  about  effective  co-operation 
of  home,  school,  and  health  authorities  in  meeting  the  de- 
mands of  the  health,  growth,  and  development  of  children 
and  youth. 

The  Establishment  of  Medical  and  Dental  Clinics  by 
Municipal  Aid,  by  Medical  and  Dental  Societies,  and  by 
Boards  of  Education. — Essential  in  this  field  of  work  is  the 
establishment  of  medical  and  dental  cUnics  to  provide  medical 
and  dental  aid  for  pupils  whose  parents  are  financially  unable 
to  pay  the  customary  fees  for  such  aid.  Cities  and  counties 
throughout  the  United  States  abound  in  large  numbers  of 
homes  in  which  parents  are  financially  unable  to  pay  the 
customary  fees,  but  many  can  pay  partial  fees.  The  embar- 
rassment resulting  by  the  making  known  of  financial  need  by 
parents,  and  many  other  difficulties,  make  the  establishment 
of  clinics  of  this  kind  a  marked  necessity. 

Clinics  of  this  order  have  been  established  and  are  being 
established  by  municipal  aid,  by  medical  and  dental  societies, 
and,  in  certain  instances,  by  boards  of  education.  The  re- 
sults are  most  valuable,  since  without  them  many  thousands 
of  children  would  never  receive  the  needed  health  and  growth 
aid;  and,  further,  the  results  are  most  valuable  in  promoting 
this  work,  since  they  give  a  tangible  meaning  to  the  service 
where  the  need  is  most  evident.  Both  parents  and  teachers 
appreciate  the  tangible  results.  The  further  development 
of  the  whole  field  of  work  thereafter  is  easier  and  more  com- 
plete.    It  ought  to  be  a  function  of  boards  of  education  either 


School  nurse  gi\'ing  parents'  notifications  to  school-children,  Toronto, 

Canada 
Note  the  equipment  of  this  nurse's  room 


School  nurses  taking  school-children  to  clinics,  Toronto,  Canada 


CITY   SCHOOL-HEALTH   ADMINISTRATION  1 63 

to  utilize  municipal  agencies  for  the  establishment  of  clinics 
of  this  order,  or  to  establish  and  maintain  such  clinics  as  a 
part  of  the  work  of  the  schools,  preferably  the  latter. 

Educational  and  Clinical  Psychology. — The  scope  and 
extent  of  psychological  examinations  and  related  work  is 
essentially  as  follows:  (i)  Investigation  of  the  hereditary 
and  family  history,  of  the  health  history,  of  the  growth  and 
development  history  of  pupils,  and  investigation  of  the  record 
of  school  activities,  physical  and  mental.  (2)  The  investi- 
gation of  the  data  of  skilled  physical  and  developmental 
examination  and  such  further  psycho-physical  examination 
as  may  be  essential  to  the  work.  The  data  of  physical  ex- 
aminations ought  to  be  supplied  by  the  medical  and  physical- 
training  examinations.  If  not,  such  examination  must  be 
made  by  examiners  in  psychological  work.  Such  data  are  es- 
sential for  a  knowledge  of  health  and  strength,  of  normal  or 
arrested  physical  growth,  and  of  functional  and  developmental 
conditions.  The  usual  medical  examinations  or  physical-train- 
ing examinations  are  not  sufficiently  complete  for  the  work  of 
clinical  psychology. 

(3)  The  Determination  of  the  Mental  Age  of  Pupils  and 
Degree  of  Development  of  Specific  Mental  Functions — Tests. — 
The  Binet-Simon  measuring  scale  for  intelligence:  tests  of 
general  intelligence,  attention,  perception,  comprehension, 
memory,  association,  imagination,  invention,  and  construc- 
tion. Learning  processes — reasoning  power,  judgment,  motor 
co-ordination,  reaction  time,  other  psychological  tests.  The 
Binet-Simon  scale  approximately  answers  the  purpose  of 
determining  mental  age.  It  has  recently  been  revised  and 
improved.  Psychologist  educators  and  physician  educators 
are  working  continually  to  ampKfy  and  perfect  this  scale. 
In  its  more  complete  development  it  will  become  a  still  more 
valuable  instrument  in  determining  mental  age — the  "mental 
station"  at  which  a  pupil  as  a  whole  has  arrived. 

Psychological  Tests  for  Specific  Mental  Functions,  Abil- 
ities, or  Traits. — During  recent  years  reliable  tests  of  specific 


164  EDUCATIONAL  HYGIENE 

mental  abilities,  together  with  the  extended  use  of  the  Binet- 
Simon  scale,  have  been  put  into  practise  (i)  in  schools  for 
the  feeble-minded;  (2)  in  the  practise  of  medicine;  (3)  in 
psychological  clinics  in  the  pubhc  schools  for  the  segregation 
of  imbeciles  and  morons  and  borderland  cases,  with  the  pur- 
pose of  assigning  special  training  in  special  schools;  (4)  to 
some  extent  in  the  public  schools  to  determine  the  specific 
development  of  specific  mental  traits  and  abilities  of  all 
pupils  so  that  educational  training  might  be  better  adjusted 
to  health,  growth,  and  efficiency  needs;  (5)  research  work  in 
normal  schools  and  universities. 

(4)  Tlie  Determination  of  Norms  of  Development  of  Specific 
Mental  Abilities. — The  evolution  of  the  work  has  been  rapid. 
The  results  on  practical  work  in  the  schools  of  recent  research 
make  it  reasonably  certain  that  in  the  near  future  reliable 
norms  of  mental  development  and  efficiency  will  be  established 
which  will  make  possible:  {a)  the  determination  of  the  nor- 
mal condition  or  acceleration  or  arrest  of  specific  mental  traits ; 
{h)  the  specific  character  of  such  arrests  or  accelerations  of 
growth;  (c)  the  improvement  which  different  traits  undergo 
from  month  to  month  and  from  year  to  year  under  the  train- 
ing which  pupils  receive  in  the  schools;  {d)  the  improvement 
resulting  from  medical  and  dental  aid. 

By  the  aid  of  such  norms  of  development  and  efficiency 
educators  can  much  more  intelligently  classify  or  grade,  as- 
sign and  adjust,  educational  activities.  While  it  is  most 
valuable  to  know  how  many  years  a  pupil's  mental  growth  is 
accelerated  or  retarded,  it  is  much  more  important  to  know 
specifically  the  development  of  specific  mental  traits  and 
abihties.  To  know  that  a  twelve-year-old  pupil  is  two  or 
three  years  accelerated  or  arrested  in  mental  development  as 
a  whole,  does  not  mean  nearly  so  much  to  educators  as  to 
know  whether  his  attention,  association,  memories,  percep- 
tion, comprehension,  different  learning  processes,  etc.,  are 
arrested  or  accelerated  in  their  specific  development  and  to 
what  extent.     It  means  just  as  much  to  know  these  facts 


CITY  SCHOOL-HEALTH  ADMINISTRATION  165 

specifically  as  to  know  the  excellence  or  defect  of  eyesight, 
hearing,  heart  action,  or  other  physical  function. 

Reliable  Mental  Tests  of  All  Pupils. — -As  far  as  practicable, 
reliable  tests  of  the  specific  mental  traits  of  all  pupils  ought 
to  be  made  at  such  periods  as  the  intelhgent  direction  of  their 
growth,  development,  and  school  activities  demands.  Careful 
records  ought  to  be  kept  and  correlated  with  the  records  of 
health  and  of  physical  growth,  and  with  the  records  of  school 
work.  This  is  a  field  for  practical  work,  investigation,  and 
research. 

By  such  procedure  school  authorities  could  adjust  edu- 
cational activities  more  intelligently  to  health,  growth,  and 
activity  needs.  The  school  grades  would  become  more  nearly 
levels  of  capacity;  individual  training  would  become  a  more 
intelhgent  fine  of  action;  a  large  amount  of  mental  retarda- 
tion would  not  occur;  the  potential  abihties  of  pupils  of  ex- 
ceptional worth  would  be  better  conserved;  truancy  pupils 
and  cases  of  incipient  crime  would  be  more  intelligently 
handled;  mental-deficiency  cases  would  be  rightly  segregated 
and  trained;  the  determination  of  fitness  for  vocational  work 
and  the  discovery  of  talent  would  be  realized  to  a  greater 
extent;  and  increased  efiiciency  would  characterize  educa- 
tional work. 

This  work  for  all  pupils  is  yet  in  its  beginning,  but  suffi- 
cient advance  has  been  made  to  justify  the  statement  that 
the  near  future  will  witness  a  marked  extension  of  the  work 
already  done  in  psychological  chnics  and  in  special  schools. 
The  results  of  progressive  work  and  research  in  the  schools 
and  research  in  universities  and  normal  schools  will  be  a  suffi- 
cient guide  to  future  progress. 

Mental  Retardation  and  Arrested  Growth— The  Conser- 
vation of  Excellence. — -This  phase  of  education  is  of  the  high- 
est importance.  There  is  a  vast  army  of  pupils  in  our  pubHc 
schools  whose  growth  is  more  or  less  arrested.  Statistics 
from  all  sections  of  the  country  show  this  condition.  It  is  a 
safe  estimate  that  out  of  the  20,000,000  pupils  in  the  public 


1 66  EDUCATIONAL  HYGIENE 

schools  of  the  nation  3,000,000  are  repeating  a  grade  a  second, 
third,  or  even  fourth  or  fifth  time,  at  a  cost  of  approximately 
$100,000,000  annually,  an  expense  largely  wasted  and  pre- 
ventable, to  say  nothing  of  the  loss  of  life  efiticiency. 

The  more  extreme  stages  of  arrested  growth,  namely,  the 
idiot,  the  imbecile,  and  moron,  afford  features  of  marked 
educational  interest  to  the  public  schools.  The  mental  age 
of  the  idiot  is  never  greater  than  that  of  a  child  of  two  years, 
no  matter  what  his  chronological  age.  The  mental  age  of  the 
imbecile  does  not  exceed  the  eight-year  level.  The  mental 
age  of  the  moron  ranges  from  eight  to  thirteen  years,  not  ex- 
ceeding the  thirteen-year  level.  Passing  these  extreme  levels 
of  arrested  growth  in  our  schools  and  homes,  all  grades  of 
mental  age  and  all  stages  of  more  or  less  marked  arrested 
growth  stand  out.  Further,  we  know  that  the  predisposition 
to  insanity  and  degeneracy  is  marked  in  the  more  extreme 
stages  of  arrested  growth,  markedly  greater  in  the  feeble- 
minded than  in  the  ordinary  population.  We  know  further 
that  arrests  of  development  of  the  more  marked  type  grade 
insensibly  into  the  higher  levels  of  arrested  growth  found  in 
large  numbers  in  our  public  schools  and  in  our  homes,  and 
that  the  same  predisposition  to  degeneracy  to  a  greater  or  less 
extent  is  an  accompaniment  of  all  stages  of  arrested  growth. 
However,  important  as  it  may  be  to  take  intelligent  care  of 
the  idiots,  the  imbeciles,  the  morons,  and  the  insane,  it  never- 
theless is  these  higher  retardation  levels  that  should  especially 
concern  us,  because  of  their  close  kinship  with  feeble-minded- 
ness  on  the  one  hand  and  with  adult  deterioration  on  the 
other. 

There  is  a  marked  need  of  systematic  and  scientific  study 
and  investigation  of  the  moral  and  criminal  traits  of  delin- 
quent and  abnormal  pupils  in  our  schools;  of  the  variation  of 
criminal  tendencies  and  moral  defect  with  physical  defect- 
iveness, with  types  of  disease,  with  transitory  states  as  ex- 
hibited in  certain  forms  of  epilepsy,  in  delusional  and  maniac 
depressive  forms  of  insanity  which  show  themselves  in  klep- 


CITY   SCHOOL-HEALTH   ADMINISTRATION  1 67 

tomaniac  and  suicidal  tendencies,  and  other  forms  of  degen- 
eracy. 

There  is  a  marked  need  to  safeguard  all  pupils,  and  es- 
pecially defective  pupils,  by  skilled  training  and  by  hygienic 
environment  against  overpressure  and  not  sufficiently  in- 
telligent handhng,  particularly  at  the  transition  periods — 
eight  to  ten  years  and  thirteen  to  fifteen  years.  The  marked 
increase  in  juvenile  crime  and  juvenile  insanity  during  the 
pubertal  years  is  a  known  condition  which  ought  to  mean  much 
in  safeguarding  all  pupils  at  the  period  of  growth  against  possi- 
ble weakness  and  inefficiency.  It  is  especially  important  to 
exercise  skilled  oversight  of  pupils  prior  to  the  transition 
periods  of  growth,  before  immoral  and  criminal  tendencies  be- 
come fixed;  before  weakness  and  inefficiency  are  allowed  to 
develop;  before  excellence  and  super-qualities,  physical  and 
mental,  are  allowed  to  remain  undeveloped. 

There  is  marked  need  of  skilled  determination  or  discovery 
of  the  supernormal  pupils  of  the  public  schools  and  the  ad- 
justment of  educational  activities  to  their  growth  and  de- 
velopment needs.  The  highest  excellence  and  genius  of  the 
race  for  the  future  is  found,  in  potential  and  evolutionary 
form,  in  supernormal  children  who  embody  in  quantitatively 
superior  degrees  those  capacities  that  are  exhibited  in  less 
degree  by  the  masses  of  the  young.  There  is  a  marked  need 
of  investigation  by  a  skilled  staff  of  the  mental  capacities, 
and  of  the  physiologic,  anthropologic,  sociologic,  and  hered- 
itary problems  underlying  their  evolution,  and  of  skilled  han- 
dling of  these  pupils.  No  type  of  pupil  has  been  so  neglected 
as  the  pupil  of  highest  excellence  and  possibiHties.  Excep- 
tional talent,  superior  capacity,  and  intelligence,  that  remain 
undeveloped  or  are  directed  in  lower  lines  of  action,  are  a  loss 
not  only  to  the  individual  but  to  the  State  and  the  nation. 

Physical  and  Psychological  Tests  and  Fitness  for  Voca- 
tional Work. — Physical  and  psychological  tests  to  ascertain 
fitness  for  vocational  work  are  an  application  of  and  an  ad- 
dition to  the  testing  above  outlined  appUed  to  the  needs   of 


1 68  EDUCATIONAL  HYGIENE 

adult  life.  Such  tests  are  especially  valuable  in  high  schools 
in  correlation  with  other  essential  work  connected  with  voca- 
tional guidance. 

Tests  for  vocational  fitness  vary  from  tests  of  vision, 
hearing,  color  discrimination,  pitch  discrimination,  and  re- 
action time  to  tests  of  general  intelligence,  of  memory,  per- 
ception, association,  accuracy  and  rapidity  of  movement,  and 
other  psychological  tests.  At  present,  as  a  part  of  a  skilled 
physical  examination,  accurate  tests  of  vision,  color  dis- 
crimination, and  hearing  are  required  of  all  recruits  for  the 
army,  navy,  and  marine  corps.  Recently  the  Binet-Simon 
tests  have  been  used  in  testing  recruits  for  the  marine  corps 
with  interesting  results.  The  testing  of  the  intelhgence  of 
army  recruits  and  of  immigrants  is  another  interesting  field 
for  investigation. 

The  management  of  steam  and  electric  railways  and  of 
electric  street-car  lines  in  different  instances  requires  ac- 
curate physical  and  psychological  examination  of  different 
employees — in  the  case  of  motormen,  psychological  examina- 
tion to  determine  ability  to  avoid  accidents.  In  different 
instances  telephone  companies  have  inaugurated  skilled  phys- 
ical and  psychological  examination  as  a  guide  in  the  selection 
of  employees.  Pilots  and  officers  of  ships,  chauffeurs,  type- 
writers, stenographers,  employees  of  automobile  companies 
for  certain  kinds  of  work,  have  undergone  skilled  physical  or 
psychological  examinations  or  both.  This  work  is  yet  in  its 
infancy  but  has  progressed  sufficiently  far  to  demonstrate  its 
value.  It  is  a  field  of  investigation  of  high  order  for  future 
vocational  efficiency.  Its  future  development  in  the  schools 
depends  largely  upon  the  efficiency  of  departments  of  educa- 
tional hygiene  of  which  it  is  a  part. 

Physical  Health  and  Psychological  Examinations  of 
Teachers. — The  health  of  teachers  is  one  of  the  most  impor- 
tant factors  of  the  pupil's  environment.  Whatever  action  is 
essential  ought  to  be  taken  by  school  authorities  to  insure 
physical  and  mental  health  as  a  fundamental  characteristic 


al 

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rtant 
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Pupils 
Field 

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e  part 
:al  ex- 
make 
pupils 


SNELLEN  TEST  SHEET, 
70ftor21m. 


D  L  N 


soft,  or  15  m. 


P  T  E  R 


40  tt.  or  12  m. 


F  Z  B  D  E 

c 


30  ft  or  9  m. 


o  r  L  C  T  G 


20  (L  or  6  m. 


APEORFDZ 


15  ft.  or  4.5  m. 

ITPRTVZBDFHKO 

If  a  cHId  cannot  read  the  thirty-foot  line  with  cither  eye,  he  should  be  referred  to  an  oculist 


• 


I 


CITY   SCHOOL-HEALTH   ADMINISTRATION  1 69 

of  the  teaching  force  of  the  public  schools.  For  this  purpose 
the  skilled  physical  and  health  examinations  furnish  essential 
data  and  should  be  required  of  all  candidates  for  teachers' 
positions  prior  to  their  employment  and  thereafter,  in  what- 
ever particulars  may  be  essential  to  protect  the  schools  against 
inefficient  teaching  due  to  lack  of  vitaUty  and  poor  health  of 
teachers,  on  the  one  hand;  and,  on  the  other  hand,  to  exercise 
such  hygienic  supervision  of  school  environment  and  curricula 
as  may  be  essential  to  safeguard  the  teachers'  occupation 
against  unhygienic  requirements  and  conditions  of  work;  to 
act  as  an  educational  force  in  establishing  such  hygienic  con- 
ditions and  requirements  of  teachers  as  shall  make  possible 
the  highest  efficiency  in  the  teachers'  profession.^ 

The  psychological  examination  of  candidates  for  positions 
as  teachers  is  logically  a  part  of  a  system  for  determining 
fitness  for  vocational  work.  This  field  is  as  yet  untried.  It 
is  a  field  for  practical  work,  investigation,  and  research. 

Psychological  testing  of  the  specific  mental  traits  and 
capacities  of  teachers  will  yield  information  not  otherwise 
to  be  obtained,  of  value  in  education  from  the  standpoint  of 
vocational  guidance.  Such  examination  will  be  valuable  to 
teachers  in  bringing  about  the  earher  recognition  of  excellence. 
The  health  and  efficiency  of  the  teaching  body  is  an  important 
aspect  of  educational  hygiene  and  as  such  requires  the  effective 
carrying  out  of  some  reasonable  and  practicable  course  of 
procedure  in  regard  both  to  the  actual  health  of  the  teach- 
ers and  to  the  conditions  and  requirements  of  the  teachers' 
work. 

Initial  Physical  and  Psychological  Examination  of  Pupils 
by  Teachers,  and  Seminar  Work  with  Teachers  in  the  Field 
of  Educational  Hygiene. — Increased  efficiency  in  education 
requires  a  certain  degree  of  skill  and  proficiency  on  the  part 
of  teachers  to  conduct  initial  physical  and  psychological  ex- 
amination of  pupils  under  the  direction  of  experts;  to  make 
preHminary  health  and  development  surveys  of  the  pupils 

1  See  Terman's  "  The  Teacher's  Health." 


170  EDUCATIONAL  HYGIENE 

over  which  they  have  charge.  Efficiency  requires  that  teach- 
ers of  special  classes  and  special  schools  should  develop  to  a 
considerable  extent  the  insight  of  the  skilled  diagnostician. 
Many  teachers  can  make  important  contributions  both  in 
general  growth  problems  and  in  diagnosis,  especially  in  the 
solution  of  specific  problems.  It  is  therefore  essential  to 
efficiency  that  experts  in  educational  hygiene  enlist  the  co- 
operation of  the  teaching  force  of  the  schools  not  only  in  the 
immediate  technical  work  of  physical  and  mental  examina- 
tions but  in  the  solution  of  specific  problems  of  educational 
hygiene  of  vital  interest  in  the  schools. 

Such  work  on  the  part  of  experts  consists  in  part  in  giving 
more  or  less  laboratory  and  technical  instruction,  including 
typical  examination  of  pupils  for  teachers,  in  the  initial  ex- 
amination of  eyesight,  hearing,  indication  of  nose  and  throat 
defects,  condition  of  teeth,  indications  of  defective  heart  and 
lung  action,  of  malnutrition,  sex  aberrations,  defective  phys- 
ical growth  and  development,  indications  of  excellence  and 
signs  of  degeneracy;  mental  examinations  of  pupils;  giving 
the  Binet-Simon  tests;  specific  tests  of  attention,  perception, 
comprehension,  memory,  association,  invention,  and  con- 
struction, learning  capacity,  etc.,  in  so  far  as  teachers  are 
quahfied. 

Associated  with  this  immediate  work  of  physical  and 
mental  examination  is  the  special  investigation  of  mental 
retardation  and  of  arrested  physical  growth — a  study  of  mental 
deficiency  in  its  varied  phases,  the  study  of  excellence  and 
genius  as  well  as  retardation  and  degeneracy.  Supplementary 
work  of  this  order  may  well  take  the  form  of  seminar  work 
in  educational  hygiene — the  results  and  problems  growing 
out  of  school  examinations  forming  the  laboratory  basis  of 
such  discussions.  The  teacher  is  the  ever-present  health, 
growth,  and  development  officer  in  the  schools;  every  school- 
room is  a  psychological  laboratory;  and  such  co-operative 
work  is  of  high  scientific  and  professional  order  and  essential 
to  a  high  degree  of  efficiency. 


CITY    SCHOOL-HEALTH   ADMINISTRATION  171 

Co-operative  Educational  Work  by  Physical  Educators, 
Instructors  in  Biology,  Medical,  Dental,  and  Psychological 
Experts. — One  of  the  needs,  and  one  of  the  opportunities,  of 
the  schools  is  the  practical  and  more  or  less  technical  teach- 
ing of  certain  phases  of  biology,  physiology,  anthropology, 
psychology,  certain  phases  of  medicine  and  dentistry,  and 
certain  phases  of  pubhc  health  work.  This  work  may  be  well 
done  in  large  classes  and  by  means  of  public  lectures.  It 
is  the  opportunity  of  the  instructors  in  biology  and  physical 
education  in  high  schools  and  of  the  medical,  dental,  and 
psychological  experts  of  city  systems  to  organize  and  carry 
out  in  co-operation  valuable  courses  of  instruction  of  this 
order,  supplementary  to  the  instruction  in  hygiene  in  the 
schools.  These  lectures  necessarily  will  be  somewhat  popular 
in  form  but  full  of  information,  and  should  contain  the  results 
of  the  latest  investigation  and  research  in  many  lines  of  work 
of  vital  interest  to  all. 

In  the  schools  the  results  of  physical  examination  and  the 
developmental  and  corrective  physical  training  constitute  a 
laboratory  of  personal  physical  hygiene.  The  results  of 
psychoclinical  examination  and  the  resulting  special  edu- 
cational training  constitute  a  laboratory  of  mental  hygiene. 
The  results  of  investigation  and  research  in  the  educational 
hygiene  work  of  the  schools  as  a  whole  constitute  a  laboratory 
basis  which  may  well  serve  as  a  basis  for  more  extended  edu- 
cational work  which  will  give  larger  perspective  to  the  work 
of  the  schools  and  will  also  be  of  pubHc  service. 

The  Planning  and  Maintenance  of  School  Buildings  and 
Grounds. — The  planning  and  maintenance  of  proper  hy- 
gienic and  physical  conditions  of  school  buildings  and  grounds 
is  a  work  of  which  the  main  purpose  and  facts  are  well  known, 
and  one  which  in  the  past  has  been  markedly  disregarded. 
Reliable  authorities  agree  in  saying  that  there  has  been  no 
place  where  all  consideration  of  health  has  been  so  disre- 
garded as  in  the  construction  of  school  buildings,  churches, 
public  halls,  and  the  buildings  of  the  average  college  or  uni- 


172  EDUCATIONAL  HYGIENE 

versity.  A  recent  writer  states:  "The  total  value  of  all  public 
school  buildings  of  America  is  $700,000,000,  but  in  point  of 
fact  one-half  of  them  are  so  abominable  that  they  should  be 
torn  down  forthwith,  and  a  quarter  more  of  them  should  be 
reconstructed."  Recent  school  buildings  are  much  better, 
and  yet  any  number  of  faulty  constructions  are  still  going  on. 
What  is  needed  is  a  yet  more  vigorous  educational  campaign 
in  what  hygiene,  sanitation,  and  efficient  living  require. 
What  is  needed  still  more  is: 

(i)  The  indorsement  of  certain  standards  and  require- 
ments in  the  planning  and  maintenance  of  school  buildings 
and  grounds  by  State  and  national  educational  and  medical 
organizations. 

(2)  The  enactment  of  legislation  which  will  define  these 
standards  and  insure  the  erection  and  modification  of  school 
buildings  in  accordance   therewith. 

A  Bureau  of  Investigation  and  Research. — Each  Depart- 
ment of  Educational  Hygiene  should  act,  so  far  as  practicable 
and  consistent  with  the  required  established  work  of  the 
schools,  as  a  bureau  of  investigation  and  research.  The 
functions  of  departments  of  educational  hygiene  are  twofold: 

(i)  Carrying  out  certain  established  work  of  the  schools. 

(2)  Research  in  the  field  of  educational  hygiene. 

Research  in  the  Field  of  Educational  Hygiene. — As 
technical  experts,  members  of  educational-hygiene  staffs  have 
a  most  important  function  in  the  field  of  research.  The  con- 
servation of  vision  is  a  marked  illustration.  About  10  per 
cent  of  school-children  have  defective  eyesight.  How  much 
of  such  defect  is  due  to  unhygienic  environment  and  activity  ? 
Ordinary  vision  requires  fifteen  to  twenty  movements  per 
minute  under  conditions  which  permit  frequent  changes  in 
accommodation.  School  work  demands  of  the  immature 
eye  one  hundred  and  fifty  to  two  hundred  separate  move- 
ments per  minute  with  the  accompanying  accurate  accom- 
modation and  convergence.  Is  the  school  work  adjusted  to 
such  changes  when  the  child  enters  school  and  thereafter? 


CITY   SCHOOL-HEALTH  ADMINISTRATION  1 73 

No  sufi&cient  standards  based  on  adequate  research  have  yet 
been  estabUshed  as  to  the  length  of  lines  and  size  of  type  for 
the  various  ages  of  school-children — shapes  of  letters,  spacing 
of  letters  and  words,  the  lighting  of  schoolrooms,  and  similar 
problems. 

Sufficiently  thorough  examination  of  eyesight  and  mus- 
cular balance  is  rarely  made  in  the  regular  physical  examina- 
tions. Every  one  knows  that  the  reflex  effects  of  eye-strain 
are  markedly  detrimental.  Is  there  not  a  much  better  con- 
servation of  vision  possible  than  exists  to-day?  The  state- 
ment is  current  that  of  the  20,000,000  school- children  in  the 
United  States  40  to  50  per  cent  contract  tuberculosis  at  least 
once  during  their  school  course  and  that  probably  2,000,000 
school-children  now  in  our  schools  will  die  of  this  disease; 
further,  that  of  these  20,000,000  school-children  probably 
half  a  million  will  sooner  or  later  become  inejB&cient  nervous 
adults  and  failures  because  of  the  different  neuroses. 

Are  these  statements  true? 

In  the  annual  report  of  the  Boston  schools  for  1913  it  is 
stated  that  out  of  110,000  school-children  of  that  city  only  150 
tuberculous  children  were  found — a  different  result  from  the 
usual  5  per  cent  quoted  as  the  number  suffering  from  tuber- 
culosis. In  how  many  cities  of  the  United  States  are  the 
usual  medical  examinations  sufi&ciently  thorough  to  diagnose 
incipient  tuberculosis  ? 

Is  it  true  that  by  segregating  the  2.000,000  school-chil- 
dren above  referred  to  and  placing  them  in  open-air  schools 
we  should  save  a  large  proportion  of  their  lives  ?  ^  Is  the  school 
a  factor  in  the  undoubted  increase  of  markedly  nervous  men 
and  women  and  in  the  increase  of  insanity?  Does  the  school 
develop  nervous  stabihty?  With  skilled  adjustment  of 
physical  and  mental  activities  might  not  a  very  large  pro- 
portion of  the  half-million  nervous  school-children  above  re- 

'  Investigations  by  Superintendent  D.  C.  Bliss,  of  Montclair,  N.  J.,  throw 
doubt  on  the  alleged  efficacy  of  fresh-air  rooms.  Psychological  Clinic  for 
May,  19 1 5. 


174  EDUCATIONAL  HYGIENE 

ferred  to  develop  excellent  nervous  stability  and  many  of 
them  marked  talent  ?  The  imbeciles,  morons,  and  borderland 
pupils  in  the  public  schools  are  undergoing  skilled  psycho- 
cHnical  examinations  and  are  being  segregated  and  placed  in 
special  schools  and  given  special  training.  Are  school  author- 
ities conserving  the  pupils  of  exceptional  ability  by  the  same 
process?  Are  school  authorities  conserving  the  abilities  of 
all  pupils  with  sufficient  skill? 

To  this  end,  research  work  for  the  establishment  of  standard 
norms  of  mental  efficiency  is  a  marked  need  of  the  hour  in 
education.  Growth  is  the  central  problem  in  education. 
Retarded  or  arrested  growth  is  responsible  for  much  of  the 
failure,  misery,  and  inefficiency  of  the  world.  So  far  as  skill 
is  available,  how  many  schools  make  sufficiently  accurate 
physical  and  mental  measurements  to  ascertain  whether 
pupils  are  growing  normally? 

Problems  in  physical  education:  in  the  discovery  and 
proving  of  mental  tests;  in  the  establishing  of  norms  of  mental 
efficiency;  medical  and  dental  matters  of  vital  interest;  the 
classification,  grading,  and  training  of  pupils  in  accordance 
with  growth  conditions;  the  heating,  Hghting,  ventilation,  and 
proper  construction  of  school  buildings;  the  psychological 
examination  of  pupils  and  teachers  for  vocational  fitness. 

These  and  many  other  problems  call  for  research  work  by 
experts  and  the  close  co-operation  of  such  experts  with  the 
teaching  force. 

Experts  in  Educational  Hygiene. — Five  classes  of  experts 
stand  out  as  best  qualified  for  work  in  this  special  field  of 
education. 

(i)  The  psychologist  educator:  an  expert  in  educational 
and  clinical  psychology  and  in  experimental  pedagogy, 
skilled  in  physical  and  mental  diagnosis  of  normal  and  ab- 
normal growth  and  development,  and  having  a  knowledge 
of  elementary  medicine. 

(2)  The  physical  educator:  skilled  in  physical  diagnosis, 
who  has  a  knowledge  of  elementary  medicine,  or  who  has 
had  a  physician's  training. 


CITY   SCHOOL-HEALTH  ADMINISTRATION  1 75 

(3)  The  skilled  physician  who  has  sufi&cient  acquaintance 
with  educational  work. 

(4)  The  skilled  dentist  who  has  sufi&cient  acquaintance 
with  educational  work. 

(5)  The  skilled  school  nurse. 

Suggested  Organization  for  Cities — under  the  control  and 
direction  of  boards  of  education  with  power  to  delegate  their 
authority  with  reference  to  the  cure  of  contagious  diseases  in 
the  public  schools  to  local  health  authorities. 

(A)  A  Department  of  Educational  Hygiene. 

Experts:  Whenever  practicable  it  is  advisable  to  include 
the  following  experts  on  the  staff  of  examiners,  qualifications 
as  stated  above,  all  under  the  supervision  of  an  expert  school 
hygienist: 

{a)  Psychologist  educators;  (&)  physical  educators;  (c) 
skilled  physicians;   {d)  skilled  dentists;    {e)  skilled  nurses. 

{B)  Division  of  the  Educational  Hygiene  Field  into  Two 
Departments: 

(i)  A  department  of  health  and  physical  development 
(medical  and  dental  super\'ision  of  schools).  Skilled  phys- 
ical examinations  essential  for  physical  education  and  for  all 
educational  work,  including  corrective  clinical  agencies. 

Department  Work :  (a)  Adequate  inspection  of  the 
schools  for  the  detection  and  prevention  of  infectious  diseases 
in  the  public  schools  and  the  reporting  of  same  to  boards 
of  health;  {h)  skilled  physical  examination  of  pupils  essen- 
tial for  a  knowledge  of  the  pupil's  health,  detection  of 
physical  defects,  fitness  for  physical  training  and  for  par- 
ticipation iii  playground  activities,  with  recommendations 
for  educational  training;  (c)  the  physical  and  health  exami- 
nation of  teachers;  {d)  sanitary  inspection  of  school  build- 
ings and  grounds;    (e)  research;    (/)  prevention  and  cure. 

Whenever  practicable  it  is  advisable  that  the  staff  of  ex- 
aminers include  the  following  experts — qualifications  as  given 
above: 

(a)  skilled  physicians;  {h)  physical  educators;  (c)  skilled 
dentists;  {d)  school  nurses. 


176  EDUCATIONAL  HYGIENE 

(2)  A  Department  of  Educational  and  Clinical  Psychology 
{Child  Study  and  Educational  Research). 

Department  Work:  By  psychological  examination  and  by 
investigation  of  the  health  and  growth  history,  of  the  hered- 
itary history,  of  the  data  of  physical  examinations,  and  of 
such  additional  data  as  may  be  essential  to  correctly  diagnose 
normal,  accelerated,  retarded,  or  arrested  growth  and  to 
recommend  educational  activities.  To  carry  forward  the 
following:  (a)  As  far  as  practicable  the  determination  of  the 
degree  of  development  of  the  specific  mental  abilities  and  the 
mental  ages  of  all  pupils  with  recommendations  for  classi- 
fication and  training;  (b)  the  more  thorough  selection  and 
discovery  of  pupils  of  exceptional  worth  (supernormal)  with 
recommendations  for  classification  and  training;  (c)  the  segre- 
gation of  mental  defectives  with  recommendations  for  classi- 
fication and  training;  (d)  special  fitness  of  pupils  and  teachers 
for  vocational  work;  (e)  research  work  in  educational  and 
clinical  psychology. 

Experts  of  the  Department:  Psychologist  Educators — quali- 
fications as  given  above.  The  co-operation  of  psychological 
experts  of  the  department  of  psychology  with  the  physicians 
of  the  medical  department  meets  the  need  for  skilled  medical 
service  when  such  aid  is  essential  in  the  department  of  psy- 
chology. The  department  of  psychology  is  a  field  for  a  cer- 
tain amount  of  practical  and  careful  constructive  work,  and 
for  a  large  amount  of  research  work  in  the  discovery  and 
proving  of  mental  tests;  in  the  estabHshment  of  norms  of 
mental  efficiency  and  related  work,  and  for  close  co-operation 
with  the  teaching  force  of  the  schools  in  the  application  of 
the  results  of  the  work  to  educational  needs. 

(C)  A  Department  of  Educational  Hygiene  representing  a 
greater  or  less  part  of  the  entire  field  of  work — whatever  part  is 
necessary  to  supplement  local  work  already  undertaken  under 
different  forms  of  organization  which  it  may  be  impossible  or 
unwise  to  reorganize — with  the  employment  of  such  experts  and 
other  employees  as  may  be  necessary  to  carry  forward  the  same. 


CITY   SCHOOL-HEALTH  ADMINISTRATION  1 77 

The  above  outlines  of  administration  may  suggest  future 
administration  where  work  has  not  been  organized,  or  may 
suggest  adjustment  of  the  entire  field  of  work  to  different 
forms  of  local  organization  which  conduct  the  work  in  part 
only. 

The  Outlook. — In  the  different  evolutionary  stages  of 
educational  hygiene  in  the  United  States  at  the  beginning  of 
191 2,  seven  States  had  enacted  mandatory  laws,  ten  States 
permissive  laws,  two  States  and  the  District  of  Columbia  had 
such  laws  that  medical  inspection  carried  on  by  city  boards 
of  health  has  the  force  of  laws.  The  remaining  States  at  the 
above  date  had  no  laws  with  reference  to  this  field  of  work.^ 

The  field  of  work,  therefore,  in  the  United  States  is  in  the 
early  stages  of  a  splendid  evolution.  For  this  reason  those 
who  shape  and  forge  the  work  ought  to  exercise  skill  and 
wisdom  equal  to  the  opportunity.  The  right  solutions  of  the 
problems  of  educational  hygiene  condition  to  a  marked  de- 
gree the  efficiency  of  all  educational  work.  That  efficiency 
may  characterize  its  administration,  the  field  of  work  should 
receive  adequate  administrative  recognition  at  the  hands  of 
school  authorities. 

Practical  plans  of  procedure  should  be  inaugurated  and 
carried  out  so  that  both  city  schools  and  rural  schools  may 
avail  themselves  of  the  work  in  its  most  efficient  forms. 
Future  State  laws  enacted  ought  to  incorporate  those  legal 
provisions  which  experience  has  proved  most  valuable,  and 
those  features  of  the  work  which  practical  work  in  the  schools 
and  research  clearly  indicate.  State  bureaus  of  educational 
hygiene  ought  to  be  established  and  State  experts  appointed 
for  the  initiation  and  State- wide  supervision  of  the  work. 
State  aid  and  county  administration  of  school  work  will 
probably  be  necessary  to  the  fullest  development. 

»  "Medical  Inspection  of  Schools,"  1913,  Gulick  and  Ayres. 


CHAPTER  XI 
RURAL  SCHOOL-HEALTH  ADMINISTRATION 

The  Rural  Health  Problem.' — Health  is  the  greatest  asset 
in  Ufe.  Upon  it  human  welfare  depends.  Not  only  is  health 
a  condition  essential  to  happiness,  but  it  is  also  of  the  highest 
economic  importance.  Hygiene  and  sanitation  are  important 
phases  of  sociology,  economics,  and  civics,  because  whatever 
affects  the  welfare  of  the  people  affects  the  welfare  of  the 
whole  State.  Almost  one-half  of  the  people  of  our  nation 
live  in  rural  communities,  and  the  welfare  of  these  people 
should  be  considered  a  vastly  important  function  of  the 
government,  because  they  are  engaged  largely  in  the  produc- 
tion of  the  materials  which,  either  raw  or  manufactured,  are 
the  essentials  of  national  life  and  progress.  The  more  efficient 
these  people  are  in  every  respect,  the  greater  the  production. 
Ill  health  and  physical  defects  on  the  part  of  those  who  pro- 
duce these  materials  are  not  only  a  loss  to  the  State  but  a 
menace  to  the  health  of  those  who  use  them.  The  sanitation 
and  health  of  rural  communities  are  therefore  subjects  of 
direct  vital  importance  not  only  to  the  rural  dwellers  them- 
selves but  to  all. 

Health  and  sanitation  being  vital  factors  to  the  welfare 
of  the  people,  it  is  a  paramount  duty  of  the  State  to  make  a 
study  of  these  problems  to  the  end  that  rehable  information 
may  be  obtained  and  made  available  to  the  people.  It  is 
furthermore  a  paramount  duty  of  the  State  to  exercise  super- 
vision over  health  conditions  in  order  that  the  causes  for  dis- 
ease, physical  defects,  and  ill  health  may  be  removed  as  far 
as  it  is  possible.    Especially  should  the  State  make  its  schools 

>  See  also  the  chapter  on  "  Rural  School  Sanitation." 
178 


RURAL  SCHOOL-HEALTH  ADMINISTRATION  1 79 

a  common  medium  for  the  dissemination  of  this  information ; 
and  in  order  to  render  this  instruction  as  effective  as  possible 
the  school  itself  should  be  a  model  hygienically.  The  State 
already  considers  the  training  of  its  citizens  academically  a 
paramount  duty  and  compels  attendance  at  school.  With 
such  compulsion  there  ought  also  to  be  a  provision  whereby 
the  State  can  guarantee  a  safe  and  sanitary  environment  for 
the  young  people  while  they  attend.  The  schools  are  the 
homes  of  the  children  for  a  large  portion  of  their  early  years, 
and  to  live  in  sanitary  surroundings  during  those  years 
means  the  inculcation  of  a  definite  sanitary  sense  which  ulti- 
mately determines  the  hygienic  standard  of  the  home. 

Improvement  of  Health  Largely  a  Matter  of  Education. — 
To  conserve,  to  develop,  and  to  enrich  human  hfe  physically, 
intellectually,  and  spiritually,  in  order  that  man  may  reach 
the  highest  development  of  which  he  is  capable,  should  be  the 
great  purpose  of  education.  Hygiene  and  sanitation  are  de- 
partments of  education  of  \dtal  importance  to  the  welfare 
and  happiness  of  all.  A  consideration  of  what  has  been  done 
to  improve  health  conditions  in  rural  schools  will  serve  as  a 
basis  for  considering  what  can  be  done  in  the  future.  Among 
the  educational  agencies  which  have  been  instrumental  in 
the  betterment  of  rural  schools  may  be  mentioned: 

(i)  School-Board  Conventions. — In  several  States  large 
meetings  of  school  officers  have  been  held  for  a  number  of 
years.  In  some  States  these  meetings  are  provided  for  by 
law  and  the  officers  are  paid  a  per-diem  and  mileage  for  at- 
tending, while  in  other  States  the  meetings  are  voluntary 
associations  or  are  held  in  connection  with  teachers'  in- 
stitutes. A  member  of  the  State  department  of  education 
and  the  county  superintendent  are  generally  in  attendance, 
and  thus  are  afforded  excellent  opportunities  for  the  depart- 
ment to  learn  the  conditions  and  needs  of  the  schools  and 
the  people.  In  Wisconsin  the  statutes  give  the  teachers  the 
right  to  attend  these  conventions  without  loss  of  pay  or  time. 
Phases  of  school  sanitation  always  come  up  for  discussion 


l8o  EDUCATIONAL  HYGIENE 

and  much  has  been  done,  not  only  to  create  better  school 
sentiment,  but  also  to  spread  information  regarding  methods 
of  managing  schools  and  caring  for  the  health  of  the  chil- 
dren and  the  community. 

(2)  Teachers^  Meetings. — Institutes  of  various  kinds  are 
held  in  most  States  and  at  such  gatherings  matters  pertaining 
to  hygiene  and  sanitation  are  frequently  taken  up.  All  States 
provide  by  law  that  physiology  and  hygiene,  with  special 
reference  to  the  effects  of  stimulants  and  narcotics,  shall  be 
taught  in  the  public  schools,  and  this  naturally  leads  to  other 
health  topics.  Some  of  the  States  have,  by  recent  enact- 
ment, provided  for  teaching  prevention  of  accidents.  In 
Michigan  the  following  law  was  enacted  in  1909: 

Section  i.  There  shall  be  taught  in  every  year  in  every  public 
school  in  Michigan  the  principal  modes  by  which  each  of  the  danger- 
ous communicable  diseases  is  spread  and  the  best  methods  for  the 
restriction  and  prevention  of  each  such  disease.  Such  instruction 
shall  be  given  by  the  aid  of  text-books  on  physiology,  supplemented 
by  oral  and  blackboard  instruction.  From  and  after  July  ist,  nine- 
teen hundred  ten,  no  text-book  on  physiology  shall  be  adopted  for  use 
in  the  public  schools  of  this  State,  unless  it  shall  give  at  least  one- 
eighth  of  its  space  to  the  causes  and  prevention  of  dangerous  com- 
municable diseases.  Text-books  used  in  giving  the  foregoing  instruc- 
tion shall,  before  being  adopted  for  use  in  the  public  schools,  have  that 
portion  given  to  the  instruction  in  communicable  diseases  approved 
by  the  State  Board  of  Health  to  the  State  Board  of  Education. 

(3)  Farmers^  Institutes,  Community  Gatherings,  and  Rural 
Organizations  of  Various  Kinds. — All  these  agencies  are  edu- 
cational and  incidentally  do  much  to  disseminate  knowledge 
concerning  hygiene.  Bovine  tuberculosis  with  the  possibil- 
ity of  its  transmission  to  human  beings  has  been  discussed 
quite  generally  and  with  much  vigor  at  farmers'  institutes. 
Home  sanitation  is  a  subject  for  earnest  discussion  in  local 
farmers'  clubs.  The  Grange  and  other  rural  organizations 
have  been  and  are  always  active  in  spreading  information 
that  will  better  rural  conditions.     The  social-centre  move- 


Cuiirlesy  of  the  Fort  Wayne  Waion  Works 

A  sanitary  school  hack  for  transporting  pupils  to  consolidated  schools 
A  small  heater  may  be  attached  to  the  bottom  of  the  wagon-bed 


Interior  of  school  hack  shown  above.     Where  a  heater  is  used  a 

register  is  placed  in  the  floor 

Driver  sits  with  the  children 


RURAL   SCHOOL-HEALTH   ADMINISTRATION  l8l 

merit  that  has  for  its  object  the  general  use  of  the  schoolhouse 
for  community  gatherings  is  gaining  strength  and  the  depart- 
ments of  education  in  various  States  are  helping  by  means  of 
bulletins  and  circulars  containing  helpful  suggestions. 

(4)  The  School. — The  rural  school  itself,  humble  though 
it  may  be,  is  becoming  a  great  agency  for  influencing  the  com- 
munity in  the  many  phases  of  rural  life.  It  is  true  that  the 
teaching  of  hygiene,  like  the  teaching  of  other  branches,  has 
not  been  productive  of  the  best  possible  results,  but  the  re- 
sults obtained  demonstrate  that  the  rural  school  can  be 
made  a  potent  factor  in  improving  conditions.  In  some  local- 
ities good  health  habits  have  been  inculcated  in  children  by 
giving  school  credit  for  personal  care  at  home,  as  outlined  in 
a  pamphlet  published  by  ex-State  Superintendent  E.  L. 
Alderman,  of  Oregon.  The  same  home-credit  plan  where 
tried  has  been  found  to  exert  a  strong  influence  in  establishing 
a  proper  attitude  toward  matters  of  health  on  the  part  of  the 
child  and  sometimes  on  the  part  of  the  older  members  of  the 
family.  One  county  superintendent  during  the  past  year, 
through  his  teachers,  school  officers,  and  the  school-children, 
made  a  campaign  on  the  house-fly;  another  on  the  care  of  the 
teeth;  and,  through  the  efforts  of  another  superintendent,  all 
of  the  school  outbuildings  of  a  county  were  placed  in  proper 
condition  and  kept  so  throughout  the  year.  Occasionally  we 
find  superintendents  and  teachers  taking  up  specific  problems 
of  sanitation  with  excellent  results;  and  these  superintendents 
and  teachers  tell  other  superintendents  and  teachers  what 
has  been  accomplished  and  they  are  often  stimulated  to  try 
the  same  things.  Can  any  one  doubt  the  far-reaching  results 
of  such  sanitary  instruction? 

The  teaching  of  physiology  and  hygiene  in  the  country 
schools  is  continually  improving:  first,  because  more  adequate 
provisions  are  made  every  year  for  training  the  teachers; 
second,  better  and  saner  text-books  are  available;  and,  third, 
the  courses  of  study  call  for  simple  and  practical  instruction. 

(5)  Literature  on   Hygiene. — In  addition  to  the  regular 


1 82  EDUCATIONAL  HYGIENE 

text-books  there  are  many  excellent  supplementary  books, 
bulletins,  and  magazine  articles  dealing  with  health  and 
sanitary  suggestions  in  a  popular  way.  The  libraries  con- 
tain many  excellent  books  for  home  reading.  In  some  of  the 
States  traveUing  libraries  are  sent  through  the  rural  com- 
munities and  these  often  contain  popular  works  on  hygiene. 
Many  of  the  State  boards  of  health  publish  and  disseminate 
excellent  bulletins  deaUng  with  various  phases  of  health. 
Public  Health,  pubHshed  by  the  Michigan  State  Board,  is 
especially  excellent.  Tracts,  leaflets,  and  circulars  deahng 
with  contagious  diseases,  the  hygiene  of  children,  and  other 
matters  pertaining  to  the  welfare  of  the  pubUc  are  published 
and  distributed  according  to  the  needs  of  each  particular 
State,  so  far  as  the  funds  will  permit.  Unfortunately,  in  many 
of  the  States  health  departments  are  not  given  the  financial 
support  that  they  should  have.^ 

It  is  also  true  that  the  general  press  of  the  country  is 
more  than  ever  interesting  itself  in  discussing  hygiene  and 
public  sanitation.  Not  only  is  more  newspaper  space  given 
to  the  subject  than  formerly,  but  the  articles  are  far  better  in 
quahty.  Though  much  of  the  material  written  on  educa- 
tional and  hygienic  subjects  is  not  high-class  and  wholly  re- 
liable, the  better  magazines  and  periodicals  are  securing  the 
services  of  the  most  eminent  medical  practitioners  and 
authorities  giving  information  of  the  highest  value. 

(6)  Training-Schools  for  Teachers. — Much  more  attention 
is  given  now  than  formerly  to  the  preparation  of  teachers  for 
rural  school  work.  Though  much  of  this  work  is  yet  in  a 
somewhat  crude  state,  yet  some  success  has  been  achieved  in 
giving  to  these  young  teachers  some  knowledge  of  the  subject- 
matter,  some  method,  and  some  definite  preparation.  A 
number  of  the  normal  schools  have  introduced  special  courses 
for  rural  school-teachers,  and  training  courses  are  being  ad- 
ministered in  connection  with  high  schools.     In  Wisconsin, 

'  The  New  York  State  Board  of  Health  is  publishing  a  health  almanac 
similar  to  those  of  Kansas  and  Virginia. 


RURAL  SCHOOL-HEALTH  ADMINISTRATION  1 83 

county  training-schools  with  two-year  courses  for  rural  school- 
teachers have  been  established.  In  these  special  schools  much 
attention  is  given  to  instruction  in  hygiene,  physical  educa- 
tion, and  school  sanitation. 

(7)  The  State  Boards  of  Health. — Reference  has  already 
been  made  to  the  Hterature  sent  out  by  these  boards.  Be- 
sides circulating  Hterature,  they  also  do  much  in  educating 
people  directly.  Members  of  boards  of  health  sometimes  ad- 
dress teachers'  institutes,  school  officers'  meetings,  and  other 
gatherings.  Through  their  regular  work  of  inspection  they 
and  the  local  boards  do  much  to  impress  upon  the  people  the 
importance  of  sanitary  surroundings.  In  many  of  the  States 
the  rules  of  the  State  board  of  health  have  the  force  and 
effect  of  law  and  many  reforms  have  been  brought  about, 
such  as  the  abohtion  of  the  common  drinking-cup. 

(8)  The  State  Department  of  Public  Instruction  and  the 
County  Superintendents. — As  far  as  time  and  means  permit, 
these  educational  forces  endeavor  to  secure  better  sanitary 
conditions  in  the  school  surroundings  and  profitable  school 
instruction  in  hygiene.  Their  responsibility  is  direct  and 
great. 

Improvements  that  Have  Been  Made  in  the  Sanitation 
of  Rural  Schools. — It  is  impossible  in  a  short  article  to  go 
into  all  the  details  of  improvement  in  the  various  States  and 
to  give  statistical  information  as  to  what  has  or  has  not 
been  done.  It  is  rather  our  purpose  here  to  tell  of  some  of 
the  things  that  have  been  done  administratively  by  the 
various  agencies  mentioned  in  order  that  we  may  be  guided 
in  further  efforts. 

(i)  School  Buildings. — In  some  of  the  States  provision 
has  been  made  by  law  for  the  condemnation  of  insanitary 
school  buildings.  In  Wisconsin  this  power  is  given  to  the 
inspectors  in  the  department  of  public  instruction,  who  are 
delegated  by  the  State  superintendent  to  inspect  school 
buildings  when  appHcations  come  to  him  for  such  inspections. 
In  the  capacity  of  State  rural-school  inspector  it  has  been  my 


184  EDUCATIONAL   HYGIENE 

pleasant  duty  since  the  law  was  enacted  in  1909  to  put  out  of 
existence  more  than  eighty  health-destroying  school  buildings. 
The  other  inspectors  in  the  department  have  also  had  their 
share  in  the  good  work,  so  that  we  now  have  inspected  and 
removed,  or  improved,  over  three  hundred  buildings.  The 
inspectors  are  empowered  to  order  a  new  building,  or  the  old 
one  repaired. 

In  North  Dakota  the  county  board  of  health,  of  which 
the  county  superintendent  of  schools  is  a  member  ex  oflficio, 
has  the  power  to  condemn  school  buildings,  and  insanitary 
school  buildings  are  often  ordered  discontinued. 

Several  of  the  States  have  made  provision  by  law  for 
the  approval  of  schoolhouse  plans  by  some  authority.  In 
certain  cases  plans  are  provided  by  the  State  and  sent  to  any 
district  desiring  to  use  them.  In  this  way  great  changes  have 
been  made  in  rural-school  architecture  and  in  rural-school 
conveniences  during  the  last  decade.  Some  State  depart- 
ments of  education  issue  bulletins  containing  suggestions  for 
remodeUing  old  schools.  In  numerous  instances  county 
superintendents  have  done  excellent  work  in  bringing  about 
improved  conditions  and  there  are  locaHties  where  many  new, 
sanitary,  up-to-date  rural  school  buildings  are  found;  and, 
as  a  rule,  when  one  such  building  has  been  erected  several 
others  are  built  in  neighboring  districts  shortly  after.  Good 
things  are  contagious  as  well  as  disease. 

(2)  Sanitation  of  School  Buildings. — The  progress  that 
has  been  made  in  school  sanitation  is  usually  due  to  one  of 
two  factors:  (a)  the  educational  work  that  has  been  done 
among  the  people  themselves  because  of  suggestions  gathered 
at  school-board  conventions,  teachers'  meetings,  community 
gatherings,  etc.;  (b)  the  State  laws  that  have  been  passed 
regulating  sanitary  conditions,  and  the  proper  administration 
of  such  laws.  Regarding  the  first  agency,  Superintendent 
J.  A.  Churchill,  of  Oregon,  writes: 

The  county  superintendents  in  a  large  number  of  counties  have 
taken  up  the  matter  of  better  sanitary  conditions  by  calling  parents' 


JNIodel  rural  school,  Kirksville,  ^le 


.?^3S**3K!!S» 


Interior  of  a  rural  school,  illustrating  method  of  ventilation,  use  of  single 
seats,  and  sanitary  drinking-fountain 


RURAL   SCHOOL-HEALTH  ADMINISTRATION  1 85 

meetings,  especially  in  the  rural  districts,  and  making  an  appeal  to 
the  people.  As  a  result  of  these  meetings  we  have  counties  in  which 
every  rural  school  building  has  the  windows  arranged  so  that  the 
light  comes  from  the  left,  where  a  special  system  of  ventilation  is  pro- 
vided or  the  windows  arranged  with  window-boards,  and  where  the 
outbuildings  are  in  absolutely  sanitary  condition.  This  work  has 
been  accomplished  through  an  appeal  to  the  people  rather  than  by 
compulsion.  The  State  board  of  health  has  helped  us  a  great  deal  in 
this  work  by  sending  lecturers. 

In  some  States,  notably  Pennsylvania  and  Indiana,  the 
law  provides  specifically  for  the  proper  sanitary  condition  of 
all  school  buildings.  In  Indiana  regulations  have  been  drawn 
up  in  the  law  for  school  sites,  school  buildings,  lighting 
and  seating,  blackboards  and  cloak-rooms,  water  supply  and 
drinking  arrangements,  heating  and  ventilation,  water- 
closets  and  outhouses.  A  penalty  is  attached  to  this  law, 
which  reads  as  follows:^ 

Any  agent,  person,  firm  or  corporation,  selling,  trading  or  giving 
to  any  township  trustee,  school  trustee  or  board  of  school  commis- 
sioners, any  materials,  supplies,  sanitary  apparatus  or  systems,  which 
when  constructed  or  remodelled  or  installed,  in  or  for  any  school  house, 
hereafter  constructed  or  remodelled,  which  do  not  in  all  respects 
comply  with  the  provisions  of  this  act,  shall  be  guilty  of  a  misde- 
meanor, and  upon  conviction  thereof,  shall  be  fined  in  any  sum  not 
more  than  five  hundred  ($500.00)  dollars,  to  which  may  be  added  im- 
prisonment in  the  county  jail  for  any  determinate  period  not  more 
than  six  (6)  months  and  shall  be  punished  by  a  further  fine  of  not  less 
than  five  ($5.00)  dollars  for  each  day  he  shall  fail  to  comply  with  any 
order  of  any  court  having  jurisdiction  for  the  correction  of  any  such 
defects  in  such  school  houses  hereafter  constructed  or  remodelled; 
and  any  money  claim  for  the  construction  or  remodelling,  or  for  any 
materials,  supplies,  sanitary  apparatus  or  systems  furnished  or  con- 
structed in  or  for  any  school  house  hereafter  constructed  or  remodelled, 
which  does  not  in  every  way  and  in  all  respects  comply  with  the  re- 
quirements of  this  act,  shall  be  null  and  void. 

(3)  Cleanliness. — In  many  sections  where  school  senti- 
ment has  been  low,  cleanliness  especially  has  been  at  a  dis- 

'  See  the  bulletin  of  the  U.  S.  Bureau  of  Education  on  "  Sanitary  School- 
houses." 


1 86  EDUCATIONAL  HYGIENE 

count.  In  some  States  laws  have  been  enacted  providing 
for  the  cleaning  of  the  schoolhouses.  Where  such  laws  have 
been  passed,  where  school  officers'  meetings  are  being  held,  and 
where  the  county  superintendent  has  the  energy  and  abiUty 
to  do  things,  we  find  some  excellent  conditions.  There  are 
localities  where  most  of  the  school  buildings  are  thoroughly 
cleaned  once  a  month.  At  least  one  State  requires,  by  a 
vigorous  statute,  the  use  of  something  to  keep  down  the 
dust  in  the  daily  sweeping  of  all  pubHc  buildings,  including 
schools.  Lest  we  become  too  optimistic  in  this  matter,  how- 
ever, let  us  remember  that  there  are  still  thousands  of  rural 
schoolhouses  that  do  not  get  more  than  an  annual  soap-and- 
water  cleaning;   but  such  are  rapidly  disappearing. 

Maine  has  on  its  statute-books  a  law  dealing  with  the 
cleanliness  of  the  children  themselves.  Several  other  States 
have  similar  laws  deaUng  with  contagious  diseases.  The 
Maine  law  reads  as  follows: 

When  a  teacher  becomes  aware  or  suspects  that  any  of  the  pupils 
attending  his  school  are  in  a  condition  which  renders  them  a  source 
of  offense  or  danger  to  the  other  pupils  in  school  on  account  of  filthi- 
ness,  or  because  they  are  the  bearers  of  vermin  or  parasites,  or  have 
an  infection  or  contagious  disease  of  the  skin,  mouth  or  eyes,  he  shall 
notify  the  superintendent  of  schools,  and  when  a  superintendent  of 
schools  knows  or  learns  that  any  of  the  pupils  attending  any  school 
within  his  jurisdiction,  are  affected  with  any  of  the  conditions,  infec- 
tions, or  diseases  herein  mentioned,  he  shall  notify  the  parents  to 
cleanse  the  clothing  and  the  bodies  of  the  children  and  to  furnish 
them  with  the  required  home  or  medical  treatment,  for  the  relief  of 
their  trouble,  and  the  superintendent  of  schools  may,  when  he  deems 
it  necessary,  exclude  such  children  from  the  schools  temporarily  or 
until  they  may  be  cured,  cleansed  and  disinfected. 

Parents  thus  notified  of  the  condition  of  their  children  shall  forth- 
with have  them  and  their  clothing  cleansed  and  shall  promptly  do 
what  is  necessary,  or  furnish  them  such  medical  treatment  as  may  be 
required  to  rid  the  children  of  vermin,  parasites,  or  contagion;  and  any 
parent  who  fails  to  do  what  is  required  so  that  the  children  may  re- 
turn to  school  with  as  little  loss  of  time  as  is  possible,  shall  be  guilty 
of  a  misdemeanor  and  shall  be  liable  to  a  fine  not  to  exceed  five  dol- 
lars for  the  first  offense,  and  not  to  exceed  ten  dollars  for  a  second  or 
subsequent  offense. 


RURAL   SCHOOL-HEALTH  ADMINISTRATION  1 87 

(4)  Seating.— In  this  matter,  as  in  everything  else  con- 
nected with  the  country  school,  progress  depends  upon  en- 
lightenment. Where  the  most  educational  work  has  been 
done  we  find  the  best  conditions.  There  are  country  schools 
in  which  no  one  could  sell  any  kind  of  desk  except  the  best. 
In  some  localities  the  people  have  no  knowledge  of  what  is 
the  best  and  frequently  do  not  care.  It  is  a  pecuHar  fact 
that  some  of  the  worst  conditions  are  often  found  in  communi- 
ties where  the  material  progress  is  the  greatest,  and  some  of 
the  worst  schoolhouses  I  have  seen  have  often  been  those  in 
wealthy  communities. 

(5)  Medical  Inspection.- — Some  progress  has  been  made  in 
the  matter  of  medical  inspection  in  rural  schools.  In  New 
Jersey  provision  is  made  for  the  medical  inspection  of  pupils 
in  all  schools.  The  law  was  enacted  in  1903  and  is  quite  com- 
plete in  its  details. 

Massachusetts  enacted  a  law  in  1906  which  makes  the 
following  provisions: 

The  school  committee  of  every  city  and  town  in  the  commonwealth 
shall  appoint  one  or  more  school  physicians,  shall  assign  one  to  each 
public  school  within  its  city  or  town,  and  shall  provide  them  with  the 
proper  facilities  for  the  performance  of  their  duties  as  prescribed  in 
this  act.  Every  school  physician  shall  make  a  prompt  examination 
and  diagnosis  of  all  children  referred  to  him,  .  .  .  and  such  further 
examination  of  teachers,  janitors,  and  school  buildings  as  in  his 
opinion  the  protection  of  the  health  of  the  pupils  may  require.  .  .  . 
The  school  committee  .  .  .  shall  cause  every  child  in  the  public 
schools  to  be  separately  and  carefully  tested  and  examined  at  least 
once  every  school  year  to  ascertain  whether  he  is  suffering  from  de- 
fective sight  or  hearing  or  from  any  other  disability  or  defect  tending 
to  prevent  his  receiving  the  full  benefit  of  his  school  work  or  requiring 
a  modification  of  the  school  work  in  order  to  prevent  injury  to  the 
child  or  to  secure  the  best  educational  results.  The  tests  of  sight  and 
hearing  shall  be  made  by  teachers. 

The  State  board  of  health  prescribes  the  directions  for 
these  tests  and  furnishes  cards,  blanks,  record  books,  etc.  A 
booklet  has  been  issued  containing  suggestions  to  teachers  and 
school  physicians. 


1 88  EDUCATIONAL  HYGIENE 

From  the  report  of  the  Massachusetts  State  Board  of 
Education  we  find  that  this  law  is  well  enforced  in  some  places, 
but  in  regard  to  enforcement  elsewhere  the  following  state- 
ments are  made: 

In  a  considerable  number  of  towns  no  general  medical  examina- 
tion of  all  the  children  has  ever  been  made.  Undoubtedly  this  general 
examination  is  far  more  important  to  the  school  and  to  the  community 
than  the  special  and  casual  ones.  It  reveals  defects  which  have  be- 
come chronic  and  which  will  permanently  and  vitally  affect  the  wel- 
fare of  the  children.  The  responsibility  for  this  examination  rests 
directly  upon  the  school  committee  and  not  upon  the  school  physician, 
unless  it  is  specifically  included  in  his  contract. 

The  report  shows  that  where  the  law  is  fulfilled  excel- 
lent hygienic  conditions  prevail,  while  in  some  communities 
"  medical  inspection  is  practically  a  nominal  affair"  and  "  there 
is  no  medical  inspection  worthy  of  the  name." 

In  Connecticut  the  law  provides  that  the  school  board 
"way  appoint  one  or  more  school  physicians  and  assign  one 
to  any  public  school  .  .  .  and  shall  provide  such  school 
physicians,  when  so  appointed,  with  proper  facilities  for  the 
performance  of  their  duties."  The  law  is  quite  explicit  as 
to  what  shall  be  done  in  case  physicians  are  appointed. 

The  State  board  of  health  in  its  biennial  report  for  1911-12 
makes  the  following  recommendations: 

We  have  had  a  law  on  the  statute  books  for  some  time  permitting 
school  boards  to  employ  medical  inspectors.  This  ought  now  to  be 
amended  so  as  to  make  medical  inspection  of  schools  obligatory. 
Some  may  think  it  a  foolish  expenditure  of  money  for  which  the  citi- 
zen should  not  be  taxed,  but  such  objections  will  not  bear  scrutiny. 
The  authority  which  has  the  right  to  compel  attendance  at  school 
has  the  added  duty  of  seeing  that  no  harm  comes  to  those  going  there, 
and  humanity  requires  that  medical  assistance  be  given  children  who 
may  suffer  through  the  ignorance  or  neglect  of  their  parents. 

With  the  lengthening  of  the  school  term  and  the  increase  in  the 
years  of  schooling  demancied,  there  has  come  an  advance  in  the  work 
required.  When  the  standards  were  low  the  work  was  not  beyond 
the  capacity  of  the  weaker  children,  but  with  fuller  courses  and  higher 
standards  this  has  changed,  and  inquiries  must  be  made  regarding  the 


RURAL   SCHOOL-HEALTH  ADMINISTRATION  1 89 

children  who  do  not  keep  up  with  their  classes,  in  order  to  diminish 
the  present  economic  waste  from  misdirected  educational  efforts. 

These  objects  can  only  be  obtained  by  a  system  of  routine  inspec- 
tion of  the  children  by  medical  men  interested  not  only  in  public 
health  but  also  in  education. 

In  New  York  the  legislature  enacted  a  law  in  1913  re- 
quiring medical  inspection  in  all  public  schools.  The  act 
also  provides  for  the  appointment  of  a  State  medical  in- 
spector of  schools,  by  the  State  commissioner  of  education. 
The  department  of  education  has  therefore  a  real  depart- 
ment of  school  hygiene. 

The  Pennsylvania  law  also  provides  for  medical  inspec- 
tion of  all  schools,  but  it  has  a  provision  to  the  effect  that 
school  districts  of  the  fourth  class  (which  would  include  rural 
districts)  may  decide  by  vote  not  to  have  inspection,  and  the 
medical  inspection  does  not  come  under  the  jurisdiction  of 
the  State  department.^ 

In  Minnesota,  Virginia,  and  Michigan  specialists  are 
employed  to  visit  as  many  schools  as  possible.  The  work 
that  has  been  done  in  Minnesota  is  given  in  the  bulletin, 
"Organized  Health  Work  in  Schools,"  published  by  the  United 
States  Bureau  of  Education. 

The  school  law  of  Utah  provides  that  the  teachers  of 
the  State  shall  conduct  certain  physical  examinations  of  the 
school-children.  These  examinations  are  made  under  rules 
prescribed  by  the  State  board  of  health.  Provision  is  also 
made  that  the  boards  of  education  may  employ  regularly 
licensed  physicians  to  make  these  tests. 

The  State  legislature  of  Ohio  enacted  a  medical-inspection 
law  in  19 13  which  makes  it  optional  for  school  boards  to 
employ  one  or  more  medical  inspectors.  Two  or  more  dis- 
tricts may  unite  in  the  employment  of  one  inspector.  The 
provision  is  made  that  the  inspector  must  be  a  regularly 
licensed  physician. 

'  See  the  Rural  School  Hygiene  Survey  by  the  Editor  in  the  Report  on 
Rural  Schools,  Superintendent  N.  C.  Schaeffer,  Harrisburg,  Pa. 


IQO  EDUCATIONAL  HYGIENE 

(6)  School  Outhiiildings. — The  toilet  facilities  in  many 
country  schools  are  inadequate  and  this  results  in  insanitary 
conditions.  School  officers'  meetings,  the  training  given  to 
teachers  for  rural  schools,  and  the  enactment  of  statutes  pro- 
viding specific  standards  for  outbuildings,  have  much  improved 
conditions  in  many  localities,  but  in  order  to  bring  about 
proper  and  permanent  results  it  is  necessary  to  secure  the  co- 
operation of  school  officers,  teachers,  parents,  and  children. 
The  improvement  of  conditions  in  these  respects  is  of  itself  a 
phase  of  the  general  educational  problem.^ 

In  the  discussion  of  the  above  topics  attention  has  been 
called  to  some  of  the  things  that  have  been  done  to  improve 
health  conditions  in  the  rural  schools.  It  has  not  been  the 
aim  to  give  a  full  account  of  the  conditions  as  they  actually 
exist.  Such  an  account  would  have  no  particular  value  in 
connection  with  this  work,  but  from  what  has  been  done  we 
can  formulate  some  plans  as  to  what  can  and  ought  to  be 
done,  and  in  planning  the  work  it  is  well  to  keep  in  mind  that 
progress  involves: 

(i)  A  campaign  to  interest  the  people  in  work  of  hygiene 
and  sanitation,  thus  securing  their  hearty  co-operation;  and, 

(2)  The  co-operation  of  all  agencies  and  forces  having 
part  in  the  work,  in  order  that  the  most  efficient  system  of 
health  supervision  may  be  established  as  described  in  a 
previous  chapter. 

Following  are  some  suggestions  made  to  improve  health 
conditions  in  rural  schools  and  through  them  general  health 
conditions  in  rural  communities. 

The  State  departments  of  education  need  to  he  strengthened 
in  many  cases.  It  should  be  kept  in  mind  that  the  State 
superintendent  is  the  educational  director  for  the  State.  The 
campaign  for  better  health  should  be  made  a  part  of  the 
regular  State  educational  propaganda,  all  forces  and  agencies 
working  under  the  direction  of,  or  in  co-operation  with,  the 

*  See  Dresslar's  bulletin  on  "  Rural  Schoolhouses  and  Grounds,"  U.  S.  Bureau 
of  Education- 


RURAL   SCHOOL-HEALTH   ADMINISTRATION  191 

department  of  education.  Enforcement  of  law  depends  upon 
popular  opinion  and  popular  will,  and  these,  in  turn,  depend 
upon  the  education  of  the  people. 

It  is  encouraging  to  note  that  the  State  departments 
in  many  States  have  been  materially  strengthened  of  late. 
In  Iowa  two  field  workers  were  added  by  the  last  legislature, 
and  in  Wisconsin  the  State  superintendent's  "official  family" 
now  numbers  fifteen  members.  In  Alabama  the  State  super- 
intendent has  been  enabled  to  secure  the  services  of  two 
rural-school  supervisors  through  an  appropriation  made  by 
the  General  Education  Board.  In  many  of  the  other  Southern 
States  one  or  more  rural  school  supervisors  are  secured  through 
appropriations  made  by  this  Board.  In  many  of  the  States 
there  is  now  possible  a  strong  organization  of  the  educational 
work. 

With  a  strong  staff  the  State  superintendent  can  direct 
effectively  a  health  programme  in  the  schools.  He  should 
have  the  aid  of  all  the  educational  agencies  of  the  State;  and 
the  services  of  the  State  university,  the  normal  schools,  and 
all  other  educational  institutions  and  forces  should  be  at  his 
disposal,  so  that  he  may  feel  free  at  any  time  to  utiHze  any 
specialist  that  may  be  adapted  for  this  work. 

With  the  strengthening  of  the  State  department  of  education 
must  come  also  a  higher  conception  in  the  minds  of  the  people 
of  the  importance  of  the  office  of  county^  district,  or  local  super- 
intendent of  schools.  This  official  naturally  holds  the  key 
to  the  educational  situation  in  his  administrative  area.  The 
county  superintendent's  position  is,  however,  often  inade- 
quately provided  for,  either  with  funds  or  with  office  assist- 
ance. With  the  limited  means  at  their  command  and  the 
great  amount  of  work  to  be  done,  it  is,  however,  surprising 
that  so  many  county  superintendents  find  time  to  be  the  real 
educational  leaders  that  they  are. 

The  State  hoards  of  health  need  strengthening  in  many 
instances,  in  order  that  on  their  own  initiative  and  in  co- 
operation with  the  State  department  of  education  they  may 


192  EDUCATIONAL   HYGIENE 

issue  publications  of  an  educational,  advisory,  and  adminis- 
trative character,  and  also  help  conduct  meetings  of  various 
kinds.  The  two  departments  working  hand  in  hand  can 
accomplish  far  greater  results  than  both  working  alone. 

The  local  hoards  of  health  need  to  be  improved  in  effi- 
ciency. In  some  States  there  are  county  boards  of  health 
or  a  county  health  officer,  while  in  other  States  the  local 
boards  have  charge  of  townships,  villages,  and  cities.  Fre- 
quently the  local  officer  is  a  physician,  but  often  he  is  not.  In 
the  latter  case  he  usually  knows  little  about  his  duties  and 
does  not  have  the  confidence  of  the  people.  In  some  States 
it  would  seem  that  conditions  could  be  improved  by  raising 
the  qualifications  of  the  local  health  official.  I  have  frequently 
been  asked  in  school-board  conventions  questions  regarding 
procedure  in  certain  cases.  When  I  have  answered  that  this 
is  a  matter  for  the  local  health  officer,  I  have  received  the 
reply:  "He  knows  no  more  about  the  matter  than  we  do." 
In  the  appointment  of  health  officers  it  should  be  kept  in 
mind  also  that  such  officials  need  to  have  tact  in  handling 
people  as  well  as  knowledge  in  handling  cases  of  disease,  es- 
pecially when  school  questions  are  involved. 

There  should  be  co-operation  between  the  local  educa- 
tional officers  and  the  local  health  officers.  The  local  school 
boards  should  be  advised  by  the  local  health  officers  in  all 
matters  pertaining  to  health,  and  all  orders  of  the  health 
officers.  State  and  local,  should  be  enforced  by  the  school 
officials.  The  plan  of  North  Dakota  to  have  the  county 
superintendent  an  ex-officio  member  of  the  county  board  of 
health  seems  good.  The  plan,  suggested  by  the  editor  of  this 
volume,  of  having  supervisors  of  hygiene  who  are  physicians 
and  physical  educators  for  rural  administrative  areas,  would 
make  for  remarkable  rural  hygiene  development. 

A  most  commendable  practice  is  to  have  also  a  local 
school  nurse  who  gives  all  her  time  to  the  schools  within  her 
jurisdiction.  Such  an  officer  would  be  a  large  factor  in  es- 
tablishing the  proper  relations  between  the  schools  and  the 


RURAL   SCHOOL-HEALTH   ADMINISTRATION  1 93 

homes.  She  would  work  under  the  direction  of  the  local 
board  of  education  and  in  co-operation  with  the  health  officer 
and  county  superintendent.  In  Wisconsin  a  law  was  enacted 
in  1913  permitting  the  county  board  of  supervisors  to  pro- 
vide for  the  employment  of  a  visiting  nurse.  In  Pennsyl- 
vania any  board  of  school  directors  may  employ  one  or  more 
school  nurses.  The  rural  school  nurse  will  probably  come 
before  the  rural  educational  hygienist,  except  as  the  latter  is 
employed  by  the  State  and  very  progressive  counties. 

A  reasonably  adequate  system  for  health  or  medical 
supervision  in  the  rural  schools  would  include  the  following: 

(i)  A  State  board  of  health  with  power  to  make  rules 
that  shall  have  the  force  of  law,  this  board  to  work  in  co- 
operation with  the  State  department  of  public  instruction  in 
its  educational  propaganda;   and 

(2)  A  State  supervisor  of  educational  hygiene,  with  as- 
sistants to  act  as  State  inspectors  as  at  present. 

(3)  A  local  board  of  education  (preferably  county)  to 
guide  the  work  in  co-operation  with  the  local  boards  of  health, 
and  school-health  officers  and  visiting  nurses  to  work  under 
the  direction  of  the  local  board,  and  all  to  execute  the  general 
orders  issued  by  the  State  boards  of  health  and  instruction. 

A  steady,  sane  campaign  in  behalf  of  better  health  is,  of 
course,  indispensable,  and  every  opportunity  and  agency 
should  be  utilized  to  spread  information  and  to  create  the 
proper  civic  sentiment. 

The  Rural  Hygiene  Working  Forces.— Having  roughly 
sketched  a  plan  for  rural  school-health  supervision,  we  may 
next  consider  its  working  forces. 

The  Teacher.— Some  inspection  and  care  must  always  be 
exercised  by  the  teacher.  She  should  know  the  symptoms  of 
common  contagious  diseases  and  be  given  authority  to  send 
home  children  having  these  symptoms,  and  the  cases  should 
then  be  referred  to  the  health  officers. 

The  teacher  should  also  have  some  knowledge  of  phys- 
ical defects  of  children,  in  order  that  she  may  be  able  to  de- 


194  EDUCATIONAL   HYGIENE 

tect  faults  of  vision,  hearing,  speaking,  etc.,  and  to  deter- 
mine their  probable  causes,  as  well  as  to  suggest  remedies. 
Here,  however,  is  where  the  great  value  of  the  school  nurse 
comes  in.  Having  special  training,  she  can  intelligently  sug- 
gest to  the  teachers  and  parents  what  ought  to  be  done  in  each 
individual  case.  By  working  with  the  teacher  and  county 
superintendent  she  can  add  immeasurably  to  the  health  and 
efficiency  of  the  school  and  the  community.  Cases  which  are 
too  difficult  for  the  teacher  to  handle  can  always  be  taken  in 
hand  by  the  nurse. 

The  teacher  should  also  be,  to  a  great  extent,  her  own 
sanitary  inspector.  A  knowledge  of  the  laws  enacted  by  the 
legislature  or  rules  passed  by  the  State  board  of  health  fixing 
certain  hygienic  standards  for  country  schools  should  be  a 
part  of  her  attainments,  and  it  should  be  the  duty  of  the 
teacher  and  the  school  board,  under  the  direction  of  the 
county  superintendent,  to  see  that  these  regulations  are  com- 
plied with.  Any  intelligent  teacher  can  in  a  short  time  read 
one  or  more  of  the  new  and  informing  books  on  school  and 
community  health. 

The  County  Superintendent. — An  inspection  of  sanitary 
conditions  can  be  made  by  the  county  superintendent  in  con- 
nection with  his  visits  to  the  schools.  He  should  have  the 
power  to  enforce  the  laws  and  rules  of  the  State  by  being 
given  the  power  to  pass  upon  a  district'' s  right  to  participate  in 
the  apportionment  of  State  school  funds.  Cases  of  physical 
defects  coming  to  his  attention  should  be  reported  to  the 
school  nurse,  the  medical  inspector,  or  the  parents. 

The  county  superintendent,  being  the  educational  leader 
of  the  county,  should  also  plan  and  arrange  for  the  discussion 
of  hygienic  topics  at  teachers'  meetings,  school-board  conven- 
tions, parents'  meetings,  and  other  gatherings.  He  should 
also  be  a  vital  factor  in  training  teachers  and  should  frequently 
visit  schools  and  classes  where  his  future  teachers  are  being 
educated  and  trained.  The  more  closely  the  students  can 
be  made  to  know  actual  conditions,  the  better  they  can  be 


RURAL   SCHOOL-HEALTH   ADMINISTRATION  1 95 

trained  to  improve  these  conditions  when  they  become  teach- 
ers. 

The  School  Nurse. — If  a  school  nurse  is  employed,  she 
should  become  the  most  important  factor  in  the  health  super- 
vision of  the  county  or  the  community.  She  should  make 
regular  inspections  of  the  pupils  under  her  jurisdiction  and 
keep  records  of  their  conditions.  She  should,  without  delay, 
visit  and  inspect  localities  where  epidemics  are  reported. 
She  should  help  the  teachers  and  county  superintendent  in 
the  various  meetings.  She  should  follow  up  cases  of  ill  health 
or  physical  defects,  and  thus  become  an  invaluable  help  to 
the  parents.  Many  valuable  suggestions  will  be  made  to  the 
teachers  incidentally  and  it  is  easy  to  see  that  in  a  short  time 
the  standard  of  efhciency  for  the  teachers  would  be  raised. 
The  nurse  should  also  be  a  vital  factor  in  the  preparation  of 
teachers  for  their  work  and  should  therefore  be  an  adviser  of 
the  faculties  having  in  charge  the  training  of  teachers. 

The  Local  Health  Officers  and  Medical  Inspector.— li  a 
visiting  nurse  is  not  secured,  most  of  the  work  she  would  do 
will  have  to  be  assumed  by  the  local  health  officer.  In  case 
a  nurse  has  been  secured,  the  work  of  the  health  officer  will 
be  largely  to  act  in  case  of  contagious  diseases,  and  to  have 
charge  of  the  legal  phases  of  the  problem,  such  as  quarantine, 
closing  school,  disinfection,  etc.  Cases  would  also  be  referred 
to  him  which  might  be  beyond  the  power  of  the  school  nurse 
to  care  for.  He  should  be  the  chief  factor  involved  in  send- 
ing defective  children  to  proper  institutions  and  the  proper 
person  to  take  the  matter  up  with  the  judge  who  has  power 
to  commit  individuals  to  such  institutions. 

The  State  hygiene  inspectors  would  be  called  upon  in  ex- 
traordinary cases  only  as  far  as  the  general  administration 
of  the  law  is  concerned.  They  would,  however,  spend  con- 
siderable time  in  the  field  studying  conditions,  in  order  that 
the  best  methods  might  be  adopted,  school  and  rural-life  hy- 
giene promoted,  and  epidemics  prevented.  Having  a  knowl- 
edge of  the  actual  health  conditions,  they  would  be  able  to 


196  EDUCATIONAL   HYGIENE 

carry  on  an  educational  health  campaign  with  the  members 
of  the  State  department  of  health,  who  also  spend  a  large 
part  of  their  time  in  the  field.  Only  under  the  wise  and  dis- 
creet leadership  of  these  two  departments  acting  together 
will  the  local  officers  and  boards  of  the  State  be  able  to  reach 
their  greatest  possible  efficiency. 


PART  III 

THE   DIVISIONS  AND  PRACTICE  OF  EDU- 
CATIONAL  HYGIENE 

I.    MEDICAL  SUPERVISION  OF  SCHOOLS 

CHAPTER  XII 

THE   STANDARDIZATION   OF   THE  SCHOOL  MEDICAL 

SERVICE 

The  Health  Census  of  School-Children. — After  a  plan  of 
administration  is  effected,  the  first  problem  confronting  school- 
health  officials  is  that  of  learning  the  exact  health  status  of 
all  the  children  in  the  school  system.  Until  a  health  census  of 
the  pupils  has  been  taken  and  an  accurate  diagnosis  of  pre- 
vailing ailments  made,  school-health  agents  do  not  know  the 
problem  they  are  to  solve.  Accurate  knowledge  of  the  phys- 
ical and  mental  natures  of  the  children  must  be  the  basis 
of  all  curative,  preventive,  educational,  and  developmental 
work.  For  this  and  other  reasons  we  set  medical  supervision 
first  among  the  five  divisions  of  school-health  practice.  It 
would  probably  be  more  attractive  to  start  with  play  and 
playgrounds  and  the  glorification  of  health  and  splendid  phys- 
ical development,  but  the  need  of  carefully  examining  our 
difficulties  and  sizing  up  the  nature  of  our  problem  probably 
outweighs  this  feature.  Too  much  of  our  educational  work  is 
now  done  in  the  dark,  with  little  sense  of  just  what  the  prob- 
lem is  which  confronts  us. 

We  need  not  trace  the  history  of  medical  supervision.  It 
started  on  an  active,  vigorous  course  only  in  the  opening  years 
of  the  twentieth  century,  although  scattered  and  feeble  efforts 
may  be  noted  before.    It  was,  in  this  country,  an  invention  of 

197 


198  EDUCATIONAL  HYGIENE 

Doctor  Durgin,  of  the  Boston  Board  of  Health,  devised  for 
the  purpose  of  lessening  the  frightful  losses  due  to  the  various 
infectious  diseases  of  childhood.  Doctors  visited  the  schools 
at  intervals  and  either  went  into  the  classrooms  to  inspect 
the  children  for  signs  of  infectious  ailments  or  had  teachers 
send  to  the  ofhce  or  doctor's  room  in  the  building  such  chil- 
dren as  the  teachers  suspected  of  showing  symptoms  of  in- 
fectious ailments.  This  was  medical  inspection,  and  it  has 
had  a  wide  vogue  and  has  done  much  good.  In  many  cities 
teachers  have  been  depended  on  almost  entirely  to  detect 
symptoms  of  ailments  and  to  isolate  the  children  on  the 
doctor's  arrival.  This  system  is  really  teacher  inspection 
rather  than  medical  inspection. 

To-day  an  entirely  new  spirit  has  entered  into  school 
medical  work — the  spirit  of  preventive  medicine.  Instead  of 
limiting  itself  to  discovering  and  isolating  contagious  dis- 
eases, an  effort  is  made  also  to  discover  and  to  correct 
physical  defects  and  incipient  ailments  before  irremediable 
damage  is  done,  and  to  place  the  whole  emphasis  upon  pre- 
vention rather  than  cure.  Instead  of  a  sHght  and  passing 
inspection  for  the  mere  signs  of  infectious  ailments,  thor- 
ough periodic  physical  examinations  of  all  pupils,  and  vigorous 
follow-up,  educational,  developmental,  preventive,  and  cura- 
tive work,  are  carried  on.  No  phase  of  preventive  medicine 
offers  more  promise  of  great  development  and  usefulness  than 
school  medical  supervision. 

In  the  plan  here  presented  the  term  inspection  is  contrasted 
with  examination,  and  both  terms  are  necessary;  consequently 
a  broader  term  than  medical  inspection  is  desirable.  In  Ger- 
many and  in  a  number  of  cities  in  this  country  the  term 
medical  supervision  has  been  used  for  this  broader  medical 
work.  Some  persons  have  recommended  the  term  health 
supervision;  but  this  is  poor  in  that  it  applies  to  the  work 
of  the  whole  hygiene  department  with  its  five  divisions. 
Since  medicine  is  broadening  to  take  in  prevention,  although 
the  latter  is  not  yet  legally  a  part  of  the  work  of  medicine 


STANDARDIZATION   OF   SCHOOL   MEDICAL   SERVICE      1 99 

as  defined  by  statute-books  according  to  Doctor  Goldwater, 
there  will  soon  be  little  or  no  objection  to  the  term  medical, 
except  from  the  ubiquitous  health  fakirs.  No  term  so  well 
covers  this  field,  it  seems,  as  medical  supervision. 

School  Examinations  and  Adult  Examinations. — The  care- 
ful routine  and  periodic  examination  of  individuals,  with  oc- 
casional less  complete  inspections  and  careful  advice  and  pre- 
ventive work,  is  not  confined  to  schools  alone.  Insurance 
companies  have  long  had  examinations,  and  lately  they  have 
quite  vigorously  entered  the  field  of  preventive  medicine.  If 
the  saving  of  lives  thus  effected  is  profitable  to  business  cor- 
porations, how  much  more  profitable  to  the  state  is  the  saving 
of  its  prospective  citizens !  Through  the  efforts  of  The  Life  Ex- 
tension Institute  principally,  many  business  organizations  out- 
side of  the  field  of  insurance  are  now  taking  upon  themselves 
the  duty  of  employing  expert  physicians  to  make  careful  phys- 
ical examinations,  periodically,  of  all  employees.  Thousands 
of  employees  are  now  getting  such  assistance.  The  examina- 
tions are  more  thorough  than  those  for  insurance,  including 
blood  pressure,  blood  analysis,  urine  and  other  tests,  and  a 
most  careful  inquiry  into  habits  of  life,  heredity,  and  slight 
symptoms  of  pathological  beginnings. 

The  disclosures  from  such  examinations  are  remarkable 
and  in  many  cases  alarming.  Doctor  S.  S.  Goldwater,  Com- 
missioner of  Health  of  New  York  City,  reports  as  follows: 
"Eight  hundred  garment- trade  workers  were  examined;  62 
per  cent  of  those  examined  were  found  to  be  in  need  of  medical 
treatment.  In  a  similar  investigation  in  Germany  fifteen  dis- 
eases or  conditions  of  physical  impairment  were  found  among 
every  ten  workers  examined.  In  a  recent  examination  of 
the  employees  of  a  New  York  City  bank  100  per  cent  of  the 
employees  were  found  to  be  abnormal  and  on  the  sure  road 
to  diseases  of  heart,  lungs,  kidneys,  or  blood-vessels."^ 

Doctor  Goldwater  and  others  maintain  the  same  position 

1  See  also  the  symposium  by  Dublin,  Winslow,  Fisk,  and  Davenport  in  the 
Popular  Science  Monthly  for  April,  1915. 


200  EDUCATIONAL  HYGIENE 

as  that  expressed  by  the  writer  on  the  first  pages  of  this  volume, 
namely,  that  preventive  medicine  and  public  health  agencies 
cannot  do  their  proper  work  and  utmost  good  until  quahfied 
physicians,  educated  in  preventive  medicine,  are  employed 
for  the  whole  population,  by  the  people,  for  the  people;  and 
that  such  health  agents  are  not  merely  for  the  treatment  of 
acute  and  advanced  cases  of  disease,  but  as  medical  advisers 
and  protectors  of  health,  for  keeping  them  well  rather  than 
getting  them  well.  More  private  physicians  must  become 
State  officials  if  we  are  ever  to  insure  the  automatic  discovery 
of  the  beginnings  of  disease  and  physical  defects,  and  especially 
of  those  various  degenerative  diseases  now  increasing  in  this 
country. 

Such  State  health  examination  and  education  must  be- 
gin at  the  beginning  of  life  and  continue  through  all  ages. 
The  work  of  the  schools  reaching,  through  school  nurses  (such 
as  are  already  employed  for  adults  by  health  departments 
and  business  firms),  the  children  of  pre-school  age  and  even 
infants,  are  not  doing  something  entirely  unique.  They  are 
working  along  the  line  of  a  common  development  which  is 
bound  to  take  place — the  socialization  of  preventive  medicine. 
In  Sweden  the  public  medical  examination  reaches  beyond 
school  life  for  most  children,  there  being  an  actively  enforced 
law  requiring  that  each  minor  under  eighteen  years  of  age  be 
medically  examined  annually,  at  the  expense  of  the  govern- 
ment, to  determine  how  far  the  work  in  which  the  youth  is 
engaged  may  have  injured  his  health.  If  the  examination 
shows  that  the  occupation  has  been  injurious  to  the  youth's 
health,  he  is  forbidden  to  continue,  and  is  given  simple  voca- 
tional guidance  of  a  health  character.  Halsey  says  that  in 
191 1  there  were  39,971  working  children  examined,  and  of 
these  501  were  assigned  to  more  hygienic  work,  while  81  were 
absolutely  forbidden  to  continue  work  and  shown  how  to 
build  up  their  health.  This  is  a  fine  beginning.  National  or 
State  insurance,  such  as  exists  abroad  in  England,  Germany, 
Austria,   and   elsewhere,   is   bringing   on   universal   medical 


STANDARDIZATION   OF   SCHOOL   MEDICAL   SERVICE      20I 

supervision;  and  the  control  of  occupational,  degenerative, 
and  infectious  diseases  will  help  it  along.  Even  now  the  State 
of  Pennsylvania  requires  at  least  monthly  expert  medical 
examinations  at  the  employers'  expense  of  all  persons  working 
in  the  lead  industries,  and  requires  elaborate  preventive 
measures  in  connection  therewith. 

School  medical  supervision  must,  then,  unite  with  the 
general  movement  of  preventive  medicine  as  its  most  prom- 
ising child.  This  whole  movement  in  general  has,  accord- 
ing to  Goldwater,  three  essential  phases: 

"  (i)  Education,  which  is  essential  to  an  understanding  of 
the  dangers  which  the  individual  encounters. 

''  (2)  Regulation,  to  prevent  environmental  conditions  which 
are  inimical  to  health. 

"  (3)  Periodic  medical  examination,  a  necessary  test  of  the 
value  and  the  effectiveness  of  education  and  of  sanitary  regu- 
lation." 

These  measures  well  describe  the  work  of  a  school  depart- 
ment of  hygiene.  As  we  have  divided  the  field,  medical  super- 
vision of  schools  limits  itself  more  to  the  study  of  the  physical 
and  mental  condition  of  the  children  and  the  cure  of  patholog- 
ical and  subnormal  conditions.  To  some  extent  also  the 
medical  examiners,  nurses,  and  workers  in  clinics  are  also 
sanitary  inspectors  of  schools,  homes,  and  community,  and 
educators  of  children,  parents,  and  pubhc.  Usually  school 
sanitation,  inspection,  and  improvement  and  the  education 
of  the  children  will  be  done  by  other  than  the  medical  workers. 
The  various  phases  of  medical-supervision  work  are  given 
below.^ 

The  Divisions  of  Medical  Supervision. — The  various 
phases  or  divisions  of  the  work  of  medical  supervision^  in 
this  plan  and,  for  the  most  part,  but  largely  unrecognized,  in 
the  best  systems  now  in  vogue,  are  about  as  follows: 

•  From  "School  Health  Administration,"  by  the  writer. 
'The  term  will  probably  remain  medical  inspection,  even  if   it  is  a  mis- 
nomer in  good  systems. 


202  EDUCATIONAL  HYGIENE 

(A)  Preliminary  clinic,  for  instruction  and  standardiza- 
tion. 

(B)  Inspections. 

(i)  Pupil  inspections. 

(a)  September  room  inspection  of  all  pupils,  by  doctors 
and  nurses. 

(b)  Occasional  room  inspections  of  classes  of  children,  by 
nurses. 

(c)  Individual  inspection,  by  teachers,  nurses,  and  doctors. 
(2)  Environmental  inspections. 

{a)   Home  hygiene  inspection,  during  home  visits  of  nurses. 
{h)  Sanitary  inspections  of  the  school  premises,  by  any 
delegated  and  competent  officer. 

(C)  Examinations,  complete  physical,  annually  for  all 
pupils. 

(i)  Scholastic:  vision  and  hearing  examinations,  and  per- 
haps others,  by  the  nurses. 

(2)  Medical:  only  those  technical  phases  which  the  nurses 
cannot  do  well,  if  any,  by  doctors. 

(3)  Psychological:  in  special  cases  where  mental  defect- 
iveness is  suspected,  by  psychologists. 

(4)  Anthropological:  measurements  of  height,  weight, 
chest-expansion,  and  the  like,  only  if  required.  Of  doubtful 
value  as  usually  made  and  followed. 

(5)  Work  certificate:  will  probably  not  be  needed  in  well- 
conducted  systems,  since  the  pupil's  health  condition  is  always 
well  known ;  but  vocational  guidance  may  play  an  important 
part  here. 

{D)  Treatment,  cure,  and  correction. 

(i)  By  home  and  family  physicians,  dentists,  or  oculists. 

(2)  By  school  nurses. 

(3)  By  dispensaries  or  other  free  clinics. 

(4)  By  public-school  chnic,  with  various  divisions. 
{E)  Prevention. 

By  looking  for  causes,  co-operating  with  other  divisions 
of  educational  hygiene,  and  other  pubHc  and  private  health 


STANDARDIZATION   OF    SCHOOL   MEDICAL   SERVICE       203 

agencies,  and  by  placing  the  emphasis  upon  preventive  rather 
than  merely  curative  agencies. 

How  to  carry  on  efficiently  and  economically  these  dif- 
ferent phases  of  the  work  will  be  the  problem  of  this  chapter.^ 

{A)   The  Preliminary  Standardization  Clinic. 

In  the  typical  city  for  which  the  reorganized  expendi- 
tures were  given, ^  with  a  proportion  of  little  over  3  per 
cent  of  current  school  expenditures  for  the  entire  depart- 
ment, including  medical  inspection,  we  have  two  physicians 
and  three  nurses  for  6,000  pupils  from  kindergarten  through 
high  school,  3,000  for  each  physician  (one,  the  director),  and 
2,000  for  each  nurse.  For  a  city  of  12,000  children  we  should 
have,  of  course,  twice  as  many  nurses  and  three  assistant 
physicians.  But  no  matter  how  large  or  how  small  the  de- 
partment may  be,  even  one  physician  and  one  nurse,  there 
should  be,  when  they  begin  to  work  together,  and,  if  several, 
at  the  beginning  of  each  year  or  oftener,  a  meetifig  at  which 
children  are  examined  or  inspected,  or  both,  and  standards  for 
referring  cases  to  parents,  for  exclusions,  for  readmissions,  for 
best  methods  of  doing  the  work,  and  the  like,  are  discussed. 
Teachers  and  principals  may  be  present  at  such  meetings, 
and  all  may  take  a  hand  in  coming  to  some  common  agree- 
ment, without  which  there  will,  in  isolation,  develop  the 
greatest  irregularity  among  different  workers  and  frequent  in- 
justice to  children  and  parents  through  conflicting  standards 
and  methods. 

This  is  also  the  opportunity  for  the  supervisor  to  outline 
the  work  of  the  year,  and  to  get  suggestions  from  all  con- 
cerned as  to  its  improvement.  It  is  a  time  for  inspiration 
and  education.  All  need  them.  Such  clinics  can  be  held  at 
one  or  more  of  the  several  schools,  if  desired,  or  at  teachers' 
meetings,  for  the  purpose  of  giving  the  teachers  necessary 
elements  of  child-study  of  a  medical  character,  which  prob- 

*See  Hoag  and  Terman's  "  Health  Work  in  the  Schools,"  pages  16  to  25. 
2  Chapter  VIII. 


204  EDUCATIONAL  HYGIENE 

ably  never  appeared  in  any  course  in  their  professional  prepa- 
ration. 

No  city  known  by  the  writer  now  employs  this  means 
for  making  efficient  medical  supervision,  and  he  hopes  for 
its  speedy  experimental  testing.  Besides  these  will  come,  of 
course,  monthly  or  semimonthly  department  meetings,  which 
are  now  quite  common  in  good  systems. 

(B)  Inspections. — (i)  Pupil  Inspections. 

(a)  September  Classroom  Inspections. — Since  this  plan  of 
administration  gives  the  physician  as  many  pupils  as  he  can 
examine  in  the  entire  year,  beginning  in  September  about 
the  third  week,  and  taking  pupils  in  the  same  order  each 
year,  we  must  provide  what  many  cities  have  been  driven 
to  by  hard  experience,  namely,  a  preliminary,  complete, 
routine,  classroom  inspection  of  all  pupils.  With  3,000 
pupils,  each  pair  of  nurses  and  physicians  will  have  about 
seventy-five  rooms,  counting  40  pupils  to  a  room.  By  requir- 
ing the  part-time  physicians  to  spend  three  hours  a  day  in 
this  first  general  inspection,  and  with  the  nurses  all  at  the 
same  work,  counting  a  classroom,  after  practice,  for  each 
half-hour,  and  records  made,  where  two  work  together,  we 
can  see  that  the  inspection  of  all  children  can  be  made  in 
about  two  weeks. 

Some  doctors  lay  claim  to  250  pupils  room-inspected  an 
hour,  but  these  are  only  very  partial  inspections,  for  signs 
of  parasitic  or  infectious  disorders.  This  first  general  routine 
inspection  would  make  a  fair  substitute  for  an  examination, 
especially  if  there  were  any  careful  attention  given  to  vision 
and  hearing.  It  is  a  general  inspection  of  the  child  for  any 
serious  defects,  ailments,  or  conditions  which  should  receive 
early  treatment  and  care.  No  vision  or  hearing  tests,  as 
such,  are  made,  but  all  obvious  cases,  like  strabismus  (cross- 
eye),  01  inflamed  eyes  from  eye-strain,  may  be  recorded  and 
referred  with  instructions. 

The  principal  ailments  found  will  probably  be  minor 
skin  ailments  of  a  filth  or  infectious  character,  although  most 


STANDARDIZATION   OF    SCHOOL  MEDICAL   SERVICE      205 

ailments  will  be  represented.  If  there  have  been  nurse  in- 
spections during  the  summer,  fewer  cases  will  be  found,  but 
there  are  always  sufficient  numbers  to  warrant  rigorous 
measures  for  nipping  their  spread  in  the  bud. 

The  Method  of  Classroom  Inspections. — The  central 
instrument  in  all  medical  supervision  ("inspection")  is  the 
individual,  cumulative  health-record  card  of  each  pupil.  On 
it  is  recorded  the  health  history  of  the  child  during  his  school 
years,  and  in  some  cases  for  the  years  pre\dous  to  his  entering 
school.  The  development  of  the  science  of  educational  hy- 
giene and  the  practical  control  of  health  matters  must  very 
much  depend  upon  such  individual  health  histories.  Scien- 
tific control  of  Hving  conditions  of  children,  or  of  any  other 
phenomena,  rests  upon  the  basis  of  accurate  and  carefully 
selected  facts.  We  present  herewith  the  faces  of  two  such 
health-record  cards  devised  by  the  writer.  For  complete 
descriptions  and  standard  keys  the  reader  is  referred  to  the 
tentative  standard  plan  above  mentioned. 

The  physician  should  usually  make  this  first  inspection 
while  the  nurse  records  and  observes  the  work  of  the  physician. 
Only  the  more  severe  cases,  the  infectious  ailments,  parasitic 
ailments,  and  the  like,  should  be  recorded  and  referred  or 
excluded  at  this  time.  Vision  and  hearing  need  not  be  tested, 
and  heart  and  lung  examinations  need  not  be  made  except  in 
special  cases. 

Care  should  be  taken  to  record  and  attempt  to  get  treated 
and  cured  only  real  and  severe  cases.  Doctors  have  a  tend- 
ency to  defeat  their  efforts  by  referring  very  minor  and  in- 
significant ailments.  Better  concentrate  on  important  cases 
and  succeed  in  getting  them  cured.  This  inspection  of  all 
children  may  be  made  in  the  rooms  or  in  the  halls  outside  the 
rooms.  Nurses  can  do  the  work  quite  well  when  trained, 
and  teachers  may  help  with  the  record  work  by  the  use  of 
the  code  given  on  the  weekly  report  by  numbers.  Exclusions 
should  be  made  for  diphtheria,  sore  throat,  tonsilitis,  scarlet 
fever,   whooping-cough,   chicken-pox,  measles,   mumps,   tra- 


2o6 


EDUCATIONAL  HYGIENE 


choma,  and  other  acute  infectious  diseases,  and  such  parasitic 
and  minor  infectious  ailments  as  prove  necessary.  Every 
effort  should  be  made  to  keep  children  in  school,  and  it  should 
never  be  necessary  to  close  schools.  Pediculosis,  impetigo, 
and  such  ailments  may  be  treated  at  home  or  school,  and  the 
children  kept  in  school.  In  several  cities  school  janitresses 
handle  pediculosis  cases. 

The  nurse  may  make  out  the  exclusion  slip,  which  should 
be  simple,  dignified,  and  adequately  instructive.  If  the  back 
can  be  used  for  health  advice,  the  chance  should  not  be 
missed.  The  seal  of  the  city  printed  on  each,  as  is  done  in 
the  State  forms  of  Massachusetts  and  certain  cities,  will  ap- 
peal in  the  right  way  to  many  parents.  The  following  ex- 
clusion form  has  several  advantages  in  the  way  of  economy: 


EXCLUSION  RECORD 

No 

Date ,  191 .  . 

School Room 

Pupil 

Address 

Cause  of  Exclusion: 


Readmitted, 


School  days  lost. 


, 191. . 


MEDICAL    SUPERVISION    OF 
SCHOOLS 


,191- 

Grade .... 


Health  City,  New  Jersey. 

Date 

School Room.  . 

Pupil's  name 

Home  address 

The  above-named  pupil  is  hereby  or- 
dered to  discontinue  attendance  at 
school  temporarily  for  the  following 
reasons: 


School  Nurse,  M.D. 
(Hand  to  pupil  excluded.) 

foverl 


This  entire  form  need  not  be  more  than  six  inches  long 
and  two  and  a  half  inches  wide. 

On  the  back  of  the  long  part,  not  the  stub,  should  be 
printed  these  and  any  other  directions,  general  advice,  or 
short  article  from  city  or  State  laws: 


STANDARDIZATION  OF  SCHOOL  MEDICAL  SERVICE       207 

The  ailment  mentioned  on  the  other  side  of  this  notice  is  infectious 
(contagious),  and  liable  to  be  transmitted,  or  "given,"  to  other  chil- 
dren.    The  child  should  receive  prompt  treatment  by  a  physician  or 

the  school  nurse,  and  should  return  to  school 

191.  .,  for  inspection  by  the  school  physician  or  nurse.  If  found  free 
from  infection  he  may  then  resume  attendance  at  school. 

Every  reasonable  effort  should  be  made  to  give  each  child  the  full 
benefit  of  every  possible  day  of  school  attendance. 


A  Duplicate  Book  for  Doctor  and  Nurse. — This  form, 
separable  from  its  stub,  should  be  printed  as  is  a  check-book, 
and,  whenever  desirable,  as  in  the  case  of  acute  infectious  dis- 
eases, will,  with  small  sheets  of  copying  carbon,  give  four 
forms,  the  original  for  the  parent,  the  stub  for  the  hygiene 
department,  the  carbon  copy  for  the  board  of  health  as  their 
notification,  and  the  carbon  stub  for  the  nurse's  or  doctor's 
record.  The  notice  can  be  sent  home  in  several  different  ways, 
depending  upon  circumstances.  One  of  these  exclusion  books 
should  be  kept  in  each  school,  and  for  its  pupils  only. 

To  avoid  conflict  of  jurisdiction,  the  city  health  officer 
and  the  director  of  hygiene',  or  superintendent,  should  meet 
and  agree  upon  a  plan  of  co-operation  for  readmitting  pupils 
after  exclusion  or  illness  absence. 

Reporting  the  Room-Inspection. — When  the  class  has  been 
room-inspected,  the  nurse  will  take  all  the  cards  of  ailing 
pupils  to  the  principal's  ofiice  or  the  health-room,  where  they 
can  be  reported  after  the  morning's  work  wdth  the  physician. 
In  her  case-book  for  each  school  she  will  write  down  the 
name,  address,  room,  and  ailment  of  each  defective  and  ail- 
ing child  and  the  date.  When  she  sends  notices  home  with 
the  children  who  are  ailing  but  not  excluded  and  gets  no 
satisfactory  results  in  treatment  within  three  days  or  a  week, 
the  time  for  a  second  notice,  or  for  home  visiting,  has  come, 
which  may  even  end  with  the  doctor's  visit  or  that  of  an 
officer  of  the  law.  After  the  list  of  cases  has  been  placed  in 
her  book  the  cards  can  be  returned  to  the  room,  where  the 
teacher  will  give  them  a  separate  place  in  her  file,  or  mark 


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Inspection,"  published  by  Teachers  College,  Columbia  University. 


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STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      213 

them  with  colored  clips.  At  the  end  of  the  day  the  nurse 
will  record  all  the  work  of  inspection  and  the  findings  in  the 
column  for  that  day's  work,  on  the  weekly  report  form. 
This  daily  and  weekly  report  will  be  treated  under  "exami- 
nations." 

(b)  Occasional  Room- Inspections. — Occasionally  other  room- 
inspections  {special  room-inspection  is  a  good  term)  must  be 
made  by  the  nurse  after  the  routine  one  in  September.  Very 
rarely  will  the  doctor  be  needed  for  such  work.  The  method 
can  be  that  of  the  general  inspection  described,  or  she  can 
simply  pass  along  the  aisles  and  inspect  the  children.  The 
latter  can  have  their  hands  on  the  desks,  and  the  nurse, 
passing  along  from  the  rear,  can  easily  note  the  condition  of 
the  hair  and  scalp,  as  well  as  other  features.  The  nurses  of 
Newark  made  an  average  of  nearly  500  occasional  classroom 
inspections  each  during  the  school  year  studied  by  the  writer, 
besides  about  21,000  individual  inspections  and  over  a  thou- 
sand home  visits  each.  These  room-inspections  are  especially 
valuable  in  poor  or  foreign  districts  in  bringing  up  the  health 
and  cleanliness  standards  toward  those  of  civilized  America. 
They  are  also  valuable,  as  suggested,  in  the  case  of  an  impend- 
ing epidemic. 

(c)  Individual  Inspections. — Individual  inspections  are  to 
be  made  principally  by  the  nurse,  but  also,  if  necessary,  by 
the  physician  in  the  one  building  he  \'isits  for  two  or  more 
hours  each  day.  Only  urgent  cases  are  to  be  referred  either 
by  nurse  or  teacher  to  the  doctor.  The  principal  classes  of 
individual  inspections  are  as  follows: 

w.  Pupils  referred  at  the  time  of  the  nurse's  visit,  by  the 
teachers. 

X.  Pupils  entering  that  school  for  the  first  time,  any  age. 

y.  Pupils  who  have  been  out  of  school  for  any  reason  more 
than  three  days,  especially  excluded,  or  quarantined  cases. 

z.  Pupils  brought  to  the  attention  of  the  nurse  in  the  homes. 

Where  principals  are,  or  become,  qualified,  a  large  num- 
ber of  the  readmittance  inspections  may  be  left  to  them. 


214  EDUCATIONAL  HYGIENE 

The  importance  of  the  health  training  of  principals  and 
teachers,  and  the  books  they  can  use  in  study,  will  be  brought 
out  later.  A  principal  who  hasn't  such  a  knowledge  of 
children  (child-study)  needs  to  "study  up."  He  must,  how- 
ever, beware  of  cocksureness  after  little  study. 

The  usual  place  for  the  individual  inspections  is  at  the 
health-room  or  the  principal's  office.  A  bell  is  rung  indicat- 
ing the  nurse's  arrival.  A  school  janitress  or  a  good  prin- 
cipal's clerk  may  be  of  great  assistance  in  getting  the  chil- 
dren ready.  Each  child  will  come  with  his  health-record 
card  in  a  fold  of  clean  paper,  and  on  this  paper  may  be 
written  the  teacher's  reason  for  sending  in  the  pupil.  He 
may  be  suspected  of  some  ailment,  or  the  teacher  has  noticed 
that  he  is  not  getting  the  treatment  previously  recommended, 
or  for  many  other  reasons,  except  as  punishment.  The  nurse 
inspects  the  child,  and,  unless  he  is  excluded,  sends  him 
back  to  his  room,  with  a  note  to  the  teacher  about  the  case 
on  the  same  folder-protector  of  the  card.  The  teacher  may 
clip  small  memoranda  shps  on  the  cards  of  pupils  who  have 
not  yet  obtained  treatment,  or  put  these  cards  in  a  special 
part  of  her  file,  or  she  may  use  the  various  colored  clip- 
markers  for  card  indexes,  each  color  of  which  may  be  given 
a  standard  meaning,  as  before  mentioned. 

The  symptom  chart  prepared  by  Doctor  E.  B.  Hoag  and 
printed  in  his  "Health  Index  of  Children,"  and  separately, 
or  some  other  set  of  indices  to  school  ailments,  such  as  are 
used  in  Cleveland,  or  printed  by  the  writer  in  American 
Education,  or  those  given  by  Doctor  Wood  in  his  "Health 
and  Education,"  will  be  of  great  assistance  to  the  teachers  in 
locating  the  children  needing  to  be  referred  to  doctor  or  nurse. ^ 
Most  of  the  present  work  of  medical  inspection  is  really 
teacher  inspection,  since  most  of  the  cases  are  first  noticed 
by  the  teachers  and  then  sent  in  to  the  doctors.  With  all 
this  responsibility,  the  teachers  have  not  been  given  a  square 
deal  in  the  way  of  health  instruction  in  the  form  of  lectures, 

'  See  also  the  bulletin  of  the  U.  S.  Bureau  of  Education,  no.  524,  pp.  130-13 1. 


STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      21 5 

clinics,  teachers'  meetings,  or  books,  by  which  to  lit  them- 
selves for  their  serious  responsibility;  and  their  normal  or 
college  courses  have  never,  in  most  probabihty,  even  touched 
upon  such  matters.  "The  child,"  to  their  professional  train- 
ing institutions,  was  quite  largely  a  disembodied  mentaUty, 
and  psychology  was  the  only  study  of  his  nature. 

DIAGNOSTIC   TABLE,   OR   SYMPTOM   CHART 

Disorders  and  Their  Indications 

(to  be  observed  by  teachers,  nurses,  and  parents) 

Teeth  Defects 

Decay  of  teeth.  Offensive  breath. 

Discoloration.  Poor  articulation. 

Crooked  teeth.  Broken  teeth. 

Prominent  teeth.  Malnutrition. 

Disorders  of  Nose,  Throat,  and  Ear 

Mouth  breathing.  Slow  mentality. 

Prominent  upper  teeth.  Deafness. 

Loud  breathing.  Poor  physical  development. 

Nasal  voice.  Earache. 

Catarrh.  Discharge. 

Running  nose.  Inattention. 

Frequent  colds.  Poor  spelling. 

Sore  throat.  Watching  of  lips. 

Offensive  breath.  Slow  progress. 

Cough.  Headache. 

Blank  expression. 

Eye  Disorders  and  Defects 

Sore  eyes  of  any  kind.  Headache. 

Sties.  Peculiar  postures  when  reading. 

Congested  eyes.  Holding  book  too  near  face. 

Crossed  eye.  Poor  reading  or  spelling. 

Squinting.  Dizziness. 

Infectious  Diseases 

Pallor.  Vomiting. 

Flushed  face.  Headache. 


2l6 


EDUCATIONAL   HYGIENE 


Eruptions. 
Scratching. 
Sleepiness. 
Lassitude. 


Cough. 

Running  nose. 
Congested  eyes. 


Nervous  Disorbers 


Inability  to  hold  objects  well. 
Spasmodic  movements. 
Twitching  of  eyes,  face,  or  any 

part  of  the  body. 
Irritability. 
Fits. 

Bad  temper. 
Fainting. 
Nail-biting. 

Undue  emotion  of  any  sort. 
Frequent  requests  to  "go  out." 


Timidity. 

Stammering. 

Cruelty. 

Perverted  tastes. 

Moroseness. 

Solitary  habits. 

Undue  embarrassment. 

Undue  activity. 

Misbehavior. 

Sex  perversions. 


Nutritional  and  General  Disturbances 


Pallor. 

Emaciation. 

Enlarged  glands  in  neck. 

Puffmess  of  face  or  eyes. 

Shortness  of  breath. 

Lassitude. 

Perverted  tastes  (e.  g.,  food). 

Slow  mentality. 


Peculiar  or  faulty  postures. 

Underdevelopment. 

Excessive  fat. 

Vicious  personal  habits. 

Low  endurance  power. 

Irritability. 

Disinclination  to  play. 

Fatigue. 


Defects  of  the  Feet 


Walking  "pigeon-toed." 
A  shuffling,  inelastic  walk. 
Toeing  markedly  out.  . 
Advancing   foot    by   exaggerated 

knee  action. 
Long  axes  of  foot  and  leg  meet  at 

unusually  wide  angles. 
Shifting  from  foot  to  foot. 
Standing  on  outer  edge  of  feet. 
Locking  knees. 
Leaning  against  wall  or  desk. 


Shoes  run  over  at  either  side. 

Front  of  heel  worn  down. 

Outer  and  back  part  of  heel  worn 
down. 

Wearing  out  of  soles  asymmetric- 
ally. 

Congestion  of  the  feet. 

Swelling,  puffiness. 

Excessive  perspiration. 

Callouses. 

Twitching  of  the  foot  muscles. 


A  thorough  physical  examination  in  Cincinnati  public  schools 


STANDARDIZATION   OF   SCHOOL   MEDICAL   SERVICE      21 7 

Incorrect  Posture 

Unequal  height  of  shoulders.  Flat  chest. 

Standing  on  sides  of  feet.  Curved  back. 

Prominent  abdomen.  Stooping. 

If  this  chart  of  symptoms  devised  by  Doctor  Hoag  is  printed  on  a 
heavy  card  and  furnished  each  teacher,  she  will  be  given  much  assist- 
ance in  doing  her  part.  See  his  "Health  Index  of  School  Children" 
mentioned  above. 

(2)  Environmental  Inspections. — After  pupil  inspections, 
according  to  our  outline,  come  environmental  inspections. 
Home  visiting,  or  home  hygiene  inspection,  by  nurses  is  about 
their  most  important  work,  and  the  problem  of  school  sanita- 
tion will  soon  come  up  in  any  thorough  system  of  medical 
supervision.  The  home-hygiene  inspections  at  the  time  of 
the  nurse's  home  \'isits  are  becoming  exceedingly  valuable 
citizen-making  institutions,  and  no  words  here  can  indicate 
the  spirit,  the  possibilities,  or  the  methods  of  that  humane 
and  scientific  work.  We  arrange  for  the  records  of  such 
visits  in  cipher  on  each  individual  record  card.  Each  nurse 
should  obtain  Doctor  Hoag's  or  Doctor  Cornell's  book,  and, 
at  least,  a  book  probably  now  published  by  the  first  munic- 
ipal school  nurse  of  America,  Mrs.  Lina  Rogers  Struthers, 
R.N.,  recently  superintendent  of  school  nurses  at  Toronto, 
and  formerly  of  New  York  City.  Doctor  Dresslar's  book  on 
"School  Hygiene"  is  also  a  desirable  volume  on  the  whole  field. 

In  certain  small  cities  the  experiment  has  been  success- 
fully tried  of  making  the  nurse  the  attendance  officer  also 
(thus  saving  another  salary  as  related),  so  that  she  can  go  to 
a  home  and  handle  a  case  of  truancy  effectively,  as  any  other 
school  "case."  The  possibilities  have  not  yet  been  half  dis- 
covered in  this  whole  field  of  home  visiting.  Even  where 
there  are  attendance  officers,  the  nurse  becomes  their  most 
valuable  assistant. 

School  sanitation  inspection  is  more  naturally  the  work 
of   the  superintendent,   director  of  hygiene,   principal,   and 


2i8  EDUCATIONAL  HYGIENE 

business  manager;  but  the  nurse  and  the  physician  should 
know  enough  about  the  subject  from  such  texts  as  Shaw's 
or  Dresslar's  books  on  ''School  Hygiene,"  or  the  other  books 
mentioned,  to  do  effective  work  in  calling  to  their  attention 
as  often  as  is  necessary  evil  conditions  of  lighting,  cleaning, 
heating,  ventilating,  the  condition  of  toilets,  the  necessity  for 
play,  playgrounds,  and  play  apparatus,  sanitary  drinking- 
fountains,  the  proper  kind  of  dusting,  and  all  such  matters. 

The  Board  of  Health  of  Philadelphia  has  a  special  card 
form  for  recording  the  facts  of  school  sanitation,  and  Doctor 
Hoag  has  a  portion  of  his  book  and  a  pamphlet  devoted  to 
a  "Sanitary  Survey  of  Schools,"  which  is  of  great  assistance 
to  the  amateur.^  Quite  frequently  the  nurse  or  the  school 
physician  will  observe  unhealthful  conditions  not  noticed  by 
teachers  or  principals  and,  then,  may  be  even  more  success- 
ful than  they  in  remedying  these  conditions.  It  depends  upon 
who  has  the  ability  to  translate  private  opinion  into  public 
opinion  and  private  scientific  knowledge  into  public  action. 

(C)  Examinations. 

There  is  no  need  of  calling  these  physical  examinations 
except  where  the  word  examination  is  (badly)  used  for  inspec- 
tion. We  have  suggested  that  a  thorough,  routine  room- 
inspection  of  children  for  all  ailments  of  a  serious  character, 
recorded  on  the  health-record  cards,  is  very  much  like  an  ex- 
amination. It  is,  however,  not  so  individual,  so  intensive, 
and  so  technically  diagnostic.  Inspections  will  frequently 
overlook  decayed  teeth  entirely,  and  will  never  include  routine 
\'ision  or  hearing  tests,  nor  will  they  ever  require,  perhaps,  the 
stripping  of  each  child  to  the  waist,  as  a  matter  of  routine  and 
without  suspicion  of  some  heart  or  lung  ailment.  An  exami- 
nation should  be  a  patient,  scientific  investigation  of  a  child's 
health  status,  regardless  of  whether  he  is  suspected  of  having 

'  Whi taker  and  Ray-Wiggin  Co.,  San  Francisco,  or  Paul  Hoeber  Co.,  69 
East  59th  Street,  New  York  City.  See  also  the  New  Jersey  form  of  114  points 
in  the  U.  S.  Bulletin,  no.  524,  pp.  127-129,  and  the  form  used  by  Doctor  Ayres 
in  the  Springfield  (111.)  School  Survey,  given  earlier.  For  rural  schools,  Doctor 
Dresslar's  government  bulletin  on  "Rural  Schoolhouses  and  Grounds." 


STANDARDIZATION   OF    SCHOOL   MEDICAL   SERVICE      219 

an  ailment.  Such  examinations  should  not  be  painfully  long 
and  impractical,  however,  in  their  minutice.  Quick,  accurate, 
and  thorough  observation  and  judgment  can  be  developed  in 
this  field  as  in  any  other.  Much  will  depend  upon  the  phy- 
sician and  the  nurse  and  what  they  have  in  their  minds  as 
questions  and  problems  regarding  each  child's  health  condition. 

The  examinations  should  be  made  in  the  health,  or  medical, 
room.  This  should  be  about  half  the  size  of  an  elementary 
schoolroom  (25  by  16),  and  be  well  lighted.  It  should  have 
both  hot  and  cold  running  water,  a  toilet  adjacent,  facilities 
for  a  combination  tub  and  shower  bath,  a  couch,  several 
chairs,  an  anteroom  for  those  awaiting  examination,  filing 
cabinets  for  case  cards  (for  systems  needing  them),  a  table 
or  desk  or  two  with  drawers,  a  medicine  cabinet,  a  white- 
enamelled  iron-and-glass  stand,  white-enamel  wash-basins, 
and  the  various  test-cards,  medicines,  and  the  like  needed 
by  nurse  and  physician.  Types  of  equipment  and  suppUes 
are  given  in  a  former  chapter.  Many  schools  add  to  these  a 
platform  scale,  usually  a  "Jones,"  with  height  standard  at- 
tached. Its  necessity  as  a  matter  of  general  routine  for  all 
school-children  is  yet  to  be  demonstrated,  however. 

The  Method  of  the  Examinations. — As  suggested,  it  will 
probably  be  best  for  the  nurse  to  be  present  each  day  during 
the  two  hours  or  more  of  the  examination,  so  she  can  confer 
with  the  physician  over  cases  and  help  in  handhng  the  chil- 
dren, making  the  vision  and  hearing  tests,  taking  the  records, 
etc.,  as  can  best  be  arranged.  Scientific  management  in  busi- 
ness does  some  of  its  best  work  with  seemingly  minor  details 
of  daily  practise.  There  is  great  opportunity  for  the  practise 
of  its  principles  in  medical  supervision  and  especially  in  the 
examinations.  This  condensation  of  the  plan,  however,  must 
limit  itself  to  bare  essentials,  in  order  not  to  exceed  all  space 
limits. 

We  have  urged  that  the  vision  and  hearing  examinations, 
once  a  year  or  less  often,  as  is  found  better,  be  given  by  the 
nurse  and  not  by  other  persons;  and  that  she  do  this,  as 


2  20  EDUCATIONAL  HYGIENE 

much  as  possible,  at  the  time  the  physician  of  her  district 
makes  his  two-hour  daily  visit  to  some  one  school.  One 
nurse  will  work  with  the  physician  at  all  times,  while  the  extra 
nurses  will  devote  themselves  to  inspections  and  home  visiting. 
Here,  at  the  ringing  of  the  bell  which  indicates  the  physi- 
cian's arrival,  or  before,  children  suspected  of  having  serious 
ailments  or  who  for  some  reason  require  immediate  attention 
are  sent  by  the  teachers  or  nurse  to  the  health-room.  At 
the  same  time  pupils  of  the  lowest  grades,  a  room  at  a  time, 
are  sent,  by  threes,  to  the  health  or  medical  (inspection) 
room.  The  nurse  quickly  inspects  the  serious  cases,  referring 
to  the  doctor  for  further  inspection  such  as  are  puzzUng,  and 
then  disposes  of  the  first  group.  If  desired,  they  may  be 
examined  at  this  time. 

She  then  prepares,  as  may  be  necessary,  a  child  (of  the 
three  mentioned)  for  the  doctor's  examination,  caUing  his 
attention  to  any  ailments  or  history  of  the  child  famihar 
to  her  and  necessary  for  him  to  utihze,  and  begins,  herself, 
to  test  the  \'ision  and  hearing  of  another  child.  By  the  time 
the  doctor  is  through  with  his  medical  examination  she  will 
perhaps  be  through  with  these  two  tests,  and  all  can  be 
recorded  on  the  health-record  card  of  the  pupil,  exclusions 
can  be  made,  or  notices  to  parents  regarding  serious  physical 
defects  or  other  ailments  signed.  Each  case  (name  of  child) 
will  be  placed  in  her  case-book,  or  on  a  case-card  on  file  in 
the  health-room  or  principal's  office.  Such  cards  for  de- 
fective pupils  are  found  necessary  in  many  cities.  The  one 
used  by  Newark  is  sent  to  the  ''department  of  medical  in- 
spection" when  the  case  is  concluded.  Cards  not  sent  in  by 
the  end  of  the  school  term  are  used  for  follow-up  work  in 
the  summer.  Whenever  a  case  is  concluded,  the  teacher 
should  be  notified.  The  word  "case"  is  frequently  used  to 
mean  both  a  single  child  and  all  his  ailments  at  any  one 
time,  and  again  each  one  of  the  ailments  found,  so  that  a 
child  might  be  six  or  more  cases  at  once.  If  the  term  is 
used  (and  it  probably  should  not  be),  it  should  refer  only  to 


STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      221 

one  child  with  all  of  his  ailments,  whether  one  or  many,  at 
any  one  time.  Usually  every  new  ailment  he  gets  will  make 
another  case.  Then,  instead  of  recording  the  number  of 
"cases,"  the  number  of  different  aihnents  should  be  given,  and 
for  a  large  group  of  children  there  will  always  be  more  ail- 
ments than  pupils — probably,  on  the  average,  two  or  more 
to  one. 

The  time  of  the  examination  should  preferably  be  from 
nine  to  eleven  each  day,  and  each  day  in  a  different  school 
during  a  week  or  longer,  depending  upon  the  number  of 
schools  it  takes  to  supply  about  three  thousand  children, 
and  somewhat  upon  the  locality,  of  course.  Perhaps  two 
thousand  for  the  doctor  and  the  same  or  fewer  for  the  nurse 
may  be  found  desirable  in  a  poor,  foreign  district.  For  small 
schools  the  doctor's  visits  should  be  distributed  over  the  year. 
A  school  with  200  pupils  will  mean  about  ten  visits,  or  one 
every  three  or  four  weeks.    Compromises  may  be  made  here. 

"If  the  nurse  and  doctor  go  to  the  same  school,  how  can 
we  have  inspection  at  other  schools  each  day?  "  some  one  may 
ask.  This  is  one  of  the  reasons  for  the  extra  nurse  in  the 
typical  city.  She  will  do  this  work.  Otherwise,  the  prin- 
cipals and  teachers  must  use  their  discretion,  as  they  have 
done  for  so  long,  until  the  nurse  can  come  in  the  late  morn- 
ing or  in  the  afternoon.  Some  of  these  daily  inspection 
visits  she  can  avoid  by  telephoning  to  a  school  and  finding 
whether  the  teachers  have  looked  and  found  any  urgent  cases. 
On  schedule,  she  will  probably  get  to  one  or  two  of  these 
other  schools  each  afternoon  anyway. 

We  cannot  go  into  further  details  with  respect  to  the 
examinations  of  various  kinds,  psychological,  scholastic, 
dental,  and  others.  There  is  little  need  of  dentists  making 
dental  examinations  when  nurses  and  doctors  give  the  neces- 
sary care  to  this  part  of  the  complete  survey  of  the  child. 
Directions  for  making  vision,  hearing,  and  mental  tests  may 
be  found  in  other  works. 

Whenever  a  referable,  non-infectious  ailment  is  found 
during  inspection  or  examination,  the  following  note  to  par- 


222  EDUCATIONAL   HYGIENE 

eiits  may  be  filled  out  from  the  cards  and  enclosed  in  an  en- 
velope by  the  nurse  to  be  sent  to  the  parents: 

Medical  Supervision  of  Schools, 
Health  City,  N.  J. 
NOTICE   TO   PARENTS   OR   GUARDIANS 
This  notice  does  NOT  exclude  the  pupil  from  school. 

Date ,  191 . . 

The  parent  or  guardian  of 

is  hereby  informed  that  a  physical  examination  by  the  school  physician 

seems  to  show  that  this  child  is  suffering  from 

You  are  advised  to  take 

this  child  to  your  family  physician  or  a specialist, 

for  advice  and  treatment  as  soon  as  possible,  in  order  that  the  pupil 
may  be  better  fitted  to  do  successfully  and  without  injury  his  school 
work. 


School  Physician. 

This  notice  may  be  placed  on  a  card  of  a  certain  color, 
say  yellow,  and  about  ^Yz  by  3M  inches  in  size.  Some  send 
all  such  messages  by  post,  but  this  is  in  most  cases  a  needless 
expense. 

On  the  back  of  the  card  may  be  printed  a  permit  by  the 
parent  for  the  nurse  to  take  the  child  to  a  clinic  or  physician 
for  medical  or  surgical  treatment,  and  an  alternative  state- 
ment that  the  parent  has  had  a  physician  and  the  result  of 
the  visit,  somewhat  as  follows: 

PLEASE    SEE   THAT   THIS   CARD   IS   RETURNED    TO   THE   TEACHER 

This  pupil  was  seen  by  Doctor on 

,  19  •• ,  with  the  following  result 


Signature  of  parent  or  guardian, 

I  desire  the  school  nurse  to  escort  my  child  to. 


for  medical  or  surgical  treatmcnl  of  the. 
Signature  of  parent  or  guardian, 


STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      223 

If  the  parent  does  not  respond  within  three  days,  and  an 
inspection  at  that  time  by  the  nurse  shows  no  evidence  of 
satisfactory  treatment,  another  notice  should  be  sent. 

If  this  notice  is  not  heeded,  and  it  should  be  printed  and 
worded  in  such  a  manner  as  to  command  attention  and  get 
results,  the  nurse  may  visit  the  home  to  help  the  parent  see 
the  need  of  the  treatment  or  to  explain  and  arrange  with 
her  the  free  treatment  at  some  dispensary,  the  school  clinic, 
or  other  similar  place.  If  the  nurse  is  unable  to  get  the 
treatment,  and  cannot  do  it  herself,  the  physician,  principal, 
or  teacher  may  attempt  the  matter. 

So  many  parents  are  so  poor  and  so  ignorant,  and  the 
provisions  for  treatment  are  so  inadequate  or  unsatisfactory, 
that  men  and  women  in  the  school  medical  service  are  soon 
driven  to  see  the  absolute  necessity  of  an  adequate  school 
clinic,  with  an  oculist  to  make  eye  examinations  and  pre- 
scribe and,  at  times,  furnish  free  glasses,  dentists  for  dental 
service,  and  surgeons  for  operative  work.  The  surgeons  or 
the  nurses  attached,  or  a  school  physician,  can  make  such 
treatments  as  are  necessary— those  for  ringworm  of  the 
scalp  with  X-rays  possibly,  for  favus,  for  trachoma,  ade- 
noids, tonsils,  etc. — and,  with  the  help  of  the  physical-edu- 
cation division,  can  give  such  medical  gymnastics  as  are  needed 
for  orthopedic,  mouth-breathing,  and  other  cases.  The  need 
for  an  open-air  school,  and  outdoor  cooler  ("uncooked")  and 
moister  air  in  the  classrooms,  will  also  soon  be  made  mani- 
fest in  even  the  best  of  cities. 

As  the  examinations  extend  through  the  entire  year,  and 
the  graduating  class  of  February  may  not  be  reached  by 
that  time,  it  will  be  well  to  give  this  class  an  examination 
early  in  the  term.  Other  children  who  may  also  be  examined 
out  of  turn  are:  all  the  children  of  a  family  when  a  parent 
has  come  to  the  examination,  as  suggested,  children  going  into 
athletic  contests  (very  important  in  some  cities),  children 
who  are  especially  referred  to  the  physician  by  the  nurse, 
or  to  the  nurse  by  the  teacher,  and  children  who  have  entered 


2  24 


EDUCATIONAL  HYGIENE 


school,  or  that  school,  for  the  first  time  after  the  pupils  of 
their  rooms  have  been  examined. 

Not  only  parental  visiting  at  the  examinations  is  desir- 
able, but  also  school  consultations  with  nurse  or  physician, 
when  the  parent  has  neglected  treatment  for  the  child,  for 
instance.  A  notice  such  as  the  following  may  be  sent,  at  the 
end  of  the  three-day  period  mentioned: 

DEPARTMENT  OF  MEDICAL  SUPERVISION  OF  SCHOOLS 

Date J  iQ-  • . 

To  the  parent  or  guardian  of 

Public  School 

You  were  notified  a  few  days  ago  that  this  child  was  found  on 
examination  by  the  school  physician  nurse  to  be  in  need  of  immediate 
treatment  for 

Please  call  at  the  school  at o'clock 

to  confer  with  the  school  physician  nurse. 


Principal. 

Cross  out  either  "physician"  or  "nurse"  where  they  are 
printed  for  alternative  use.  This  card  may  be  white  in 
color  and  334  by  5^^  inches  in  size.  Other  devices  to  obtain 
treatment  will  be  invented  by  the  thoughtful  and  interested 
nurse,  physician,  or  principal.  Some  cities  use  attendance 
ofl&cers  to  force  children  in  whom  the  doctor  or  nurse  will 
not  admit  till  treated  or  cured.  Notice  is  also  sometimes 
sent  that  parents  are  keeping  children  out  illegally,  even 
though  excluded  or  referred  for  treatment. 

When  the  time  has  come,  three  days  after  notification, 
and  the  pupil  is  in  school,  the  teacher  sends  the  pupil  in  for 
the  nurse's  or  physician's  inspection  to  see  if  the  cure  has 
been  obtained.  No  record  of  cure  or  treatment  is  ever  to  be 
made  without  such  inspection.  The  teacher's  opinion  is  not 
enough.  Doctor  Foster,  of  Oakland,  California,  has  his  nurses 
record  cures  at  the  first  routine  inspection  only,  and  these 
for  ailments  found  the  year  previous.    Cures  take  time. 


STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      22^ 

A  further  attempt  at  accuracy,  co-operation,  and  a  check 
on  the  work  of  doctor  and  nurse,  is  the  principal's  monthly 
report  based  upon  his  own  and  the  teachers'  records.  This 
may  be  made  very  briefly  as  a  part  of  the  monthly  report. 
The  following  tentative  standard  classification  and  termi- 
nology with  probable  frequency  of  ailments  should  be  used 
for  weekly  and  annual  reports. 

School  Ailments  and  Defects  with  Probable  Number 

OF  Ailments  to  be  Found  Among  a  Thousand 

Elementary  Pupils 

I.     NON-COMMUNICABLE  AILMENTS 

A.  Physical  Defects. 

1.  Adenoids,  nasal  obstruction,  etc 50 

2.  Anemia 10 

3.  Deafness,  defective  hearing 5 

4.  Dental,  teeth  defects 660 

5.  Enlarged  tonsils 60 

6.  Eyesight,  vision  defects 70 

7.  Eyes  crossed,  strabismus,  squint 7 

8.  Glands  enlarged,  adenitis 10 

9.  Heart  defects 9 

10.  Lungs  very  weak,  not  tubercular 5 

11.  Malnutrition,  debility,  indigestion,  "general  condition"  20 

12.  Mentality 10 

13.  Nervousness,  chorea,  habit  spasm,  nervous  exhaustion  2 

14.  Palate  defects 7 

15.  Skeleton,  orthopedic  defects  (flat-foot,  club-foot,  etc.)  2 

16.  Spine:  curvature,  posture,  round  shoulders,  etc 8 

17.  Speech:  stuttering,  stammering,  lisping,  etc 9 

B.  Common  Ailments. 

18.  Abscess,  boils,  etc 5 

19.  Acute  sore  throat,  cough,  etc 2 

20.  Bronchitis i 

21.  Cleanliness  needed 20 

22.  Catarrh,  rhinitis 10 

23.  Colds,  bad.     Coryza 3° 

24.  Ear  discharge,  otitis  media 15 

25.  Ears:  earwax  (impacted   cerumen),  foreign   bodies, 

etc.,  minor S 


2  26  EDUCATIONAL  HYGIENE 

26.  Eczema 7 

27.  Eyes:  "sore,"  blepharitis,  sties,  iritis,  etc.,  minor...  20 

28.  Headache  (a  symptom),  migraine,  neuralgia 15 

29.  Laryngitis 5 

30.  Nosebleed,  epistaxis 2 

31.  Pharyngitis,  chronic  sore  throat 3 

32.  Rheumatism i 

i^.  Sex  ailments  and  habits 10 

34.  Skin  ailments,  minor;  herpes,  seborrhoea,  acne  (black- 

heads), etc 15 

35.  Stomatitis,  mouth  ulcers,  "canker  sores" i 

36.  Wounds,  sores,  sprains,  poison-ivy,  chilblains,  "first- 

aid,"  etc •  •■•  150 

37.  Urinary  ailments,  incontinence  of  urine,  eneuresis. . .  2 

II.     COMMUNICABLE  AILMENTS 

A.  Parasitic  and  Minor  Infectious  Ailments. 

38.  Conjunctivitis,  "pink  eye,"  etc 30 

39.  Favus,  yellow  scalp  sores i 

40.  Impetigo  "contagioso,"  infectious  sores 20 

41.  Influenza,  grippe,  infectious  colds  of  a  serious  char- 

acter    I 

42.  Pediculosis,  head  lice  and  vermin 50 

43.  Ringworm,  body  and  scalp 4 

44.  Scabies,  itch 5 

45.  Tonsilitis,  quinsy 10 

B.  Infectious  Diseases. 

46.  Chicken-pox 6 

47.  Diphtheria 2 

48.  Measles 4 

49.  Mumps 4 

50.  Scarlet  fever 4 

51.  Trachoma,  "granulated  eyelids" i 

52.  Tuberculosis  of  the  lungs,  "consumption" i 

53.  Tuberculosis  of  the  bones  and  other  parts  of  the  body         i 

54.  Whooping-cough,  pertussis 2 

Total 1,409 

(D)  Treatment,  Cure,  and  Correction. — First-class  school 
clinics,  as  free  to  the  children  as  text-books  but  carefully 
regulated  by  the  school  officials,  are  sure  to  be  made  a  part  of 


STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      227 

all  school  systems,  first  in  the  poorer  parts  of  the  larger  cities, 
but  later  everywhere.  This  is  the  cheapest  and  best  means 
the  community  can  take  to  develop  real  preventive  medicine, 
for  the  small  amount  of  cHnic  treatment  in  the  child's  school 
period,  and  before,  will  mean  the  early  detection  and  eradica- 
tion of  many  grave  pathological  beginnings.  '  A  permanent 
tooth  lost,  for  example,  can  never  be  replaced.  It  is  gone  for- 
ever; and  no  less  an  ideal  than  the  saving  of  nearly  all  teeth 
up  to  the  age  of  twenty  and  beyond  can  be  long  tolerated. 

But  such  thoroughgoing  clinics  will  be  long  in  coming,  as 
shown  in  the  chapter  on  that  subject,  and  many  substitute 
measures  must  be  employed.  Parents  and  family  physicians 
must  always  be  given  the  first  chance  for  most  ailments, 
even  when  their  work  is  poor.  Dental  work  may  be  accom- 
plished by  the  use  of  a  travelling  chair  sent  from  school  to 
school  and  manned  by  voluntary  or  paid  dentists.  It  is  com- 
paratively easy  to  get  individuals  or  private  organizations  to 
give  much  valuable  service  in  this  direction.  The  splendid 
work  being  done  abroad  can  be  learned  in  Doctor  Cruick- 
shank's  volume  on  "School  Clinics  at  Home  and  Abroad." 
No  book  has  yet  been  written  on  the  work  being  done  in  this 
country. 

(£)  Prevention. — All  the  work  of  medical  supervision  is 
preventive  from  the  Hfe  standpoint,  but  the  emphasis  should 
be  strong  on  this  phase  as  in  no  other  phase  of  human  effort. 
The  medical  supervisor  must  interest  himself  in  the  physical- 
education  department,  not  only  for  medical  g>Tnnastics 
and  training  of  mouth-breathers,  but  for  building  up  gen- 
eral bodily  resistance  and  vigor.  The  consultation  hours  for 
mothers,  now  becoming  common  in  schools,  will  help  to  get 
prevention  at  work  very  early  with  the  Httle  children  yet  in- 
fants. Co-operation  with  all  agencies  will  centre  the  best  ef- 
forts of  the  community  on  adequate  health  protection. 

Superintendent's  Annual  Report  on  Medical  Inspection. — v^ 
Much  in  the  way  of  progress,  records,  and  education  of  the 
public  depends  upon  the  character  of  this  annual,  public  re- 


2  28  EDUCATIONAL  HYGIENE 

port.  The  number  of  pages  of  the  present  reports  devoted 
to  this  subject  varies  greatly  even  by  percentages.  South 
Manchester,  Connecticut,  probably  gives  a  larger  share  of  its 
report  to  these  newer  health  matters  than  any  other  city. 
The  plan  of  coming  around  to  health  matters  every  few 
years  for  intensive  and  comparative  treatment,  while  emphasiz- 
ing certain  general  features  every  year,  is  to  be  commended. 
Some  of  the  features  of  the  regular  report  may  well  be : 

(i)  The  summary  of  the  weekly  reports,  which  have 
been  summarized  for  the  newspapers  and  for  each  monthly 
board  meeting  during  the  year,  both  as  to  ailments  and  the 
general  features  given  on  both  sides  of  the  weekly  report. 

(2)  Comparison  with  the  work  of  former  years. 

(3)  Interpretation  of  the  data  presented. 

(4)  Some  of  the  interesting  cases  handled  during  the 
year,  to  give  the  intimate  personal  side,  with  photographs, 
if  possible. 

(5)  Emphasis  on  the  percentage  of  ailments  cured. 

(6)  The  principal  needs  and  problems,  and  what  parents 
can  do  to  help. 

(7)  Appreciative  words  for  the  various  voluntary  health 
agencies  that  have  helped  during  the  year,  the  newspapers, 
bequests  for  school  clinics,  etc.  How  the  various  divisions 
of  the  hygiene  department  have  co-operated. 

(8)  A  general  estimate  of  the  health  conditions  of  the 
school-children. 

Measuring  the  Efficiency  of  Medical  Supervision  Systems. 
— The  principal  efficiency  tests  are  the  percentage  of  the 
serious  ailments  existing  in  the  school  population  that  have 
been  found  and  the  percentage  of  the  ailments  found  that 
have  been  cured.  The  decrease  in  ailments  found  from 
year  to  year  due  to  prevention  and  curative  measures  (not 
to  changes  in  the  standards  of  inspectors)  is  a  third  essential 
factor.  The  estimate  given  above  of  the  approximate  per- 
centages of  serious  ailments  to  be  found  in  an  ordinary  school 
population  at  the  present  time,  may  be  used  for  comparison. 


Total  numbei 
in  one  schoo;NTS 
both  doctors  t 
frequency. 

Pediculosis,    |"*^^ 
Dental  defect^^^"" 
Enlarged     toi 
Adenoids   anijTOTAL 
Wounds,  sord 


Eyesight,  via 
Impetigo     cot 

cfandf  enlar^05«  OF  TOTAL 
Conjunctivitii 

Skin  ailment 
Ringworm  . 
Anemia  .  .  .  .i 
Eye  ailments 
Malnutrition, 

Tonsilitis,    q£R  9Q^  OF  TOTAL 
Deafness,    hi 
Scabies,    itch 
Mumps     .... 
Scarlet   fevei 

Ear  discharg 
Measles  .... 
Chicken  pox 
Diphtheria  , 
Heart   defec< 


Pharyngitis 
Eyes  crossed 
Catarrh,  rhii 
Skeleton,'  or 
Palate   defe< 

Whooping   cj 
Headache,  rn 
Mentality  de 
Colds,   bad. 
Lungs  weakj 

Nervousness 
Tuberculosis 
Bronchitis     . 
Cleanliness 
Speech    def^ 

Abscesses,  bi 
Sore    throat. 
Trachoma,  g 
Laryngitis 
Spine,  curva 

Ears,    minoi 
Favus,  yello 
Urinary,  eiv 
Nose-bleed 
Stomatitis, 

Influenza,  g 
Sex  ailmenl 
Tuberculosil 
Rheumatism 


IN    25    CITIES 


E      229 

are  the 

I  to  the 
.tion  to 

super- 
ted  and 

•  it  em- 
records 

ysicians 
sndance 

)sing  of 
quaran- 

irses,  to 

:ause  of 
y^giene. 

m  may  be 
d1  Medical 
New  York 


RELATIVE    FREQUENCY    OF    SCHOOL   AILMENTS    IN    25    CITIES 


FIRST  FIVE,  60:5  OF  TOTAL 


viin,  >n 

",.:::: 

lis 

orlhopedi 

!?^:; 

"■.;i;;';; 

.'.'f;:;: 

.,,::., U 

'■"-" 

H.:'°'w'i 

l,^ 

".:.::: 

i^B 

'^ 

p'oVii;; 

s,";.mi 

"liJJJi- 

.i;;i-;: 

Tjif'S 

■°?  o'fbo 

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FIRST  TEN,  NEABI.V  80^  OF  TOT«L 


FIRST  EIGHTEEN,  OVER  90*  OF  TOTAL 


3 


STANDARDIZATION   OF   SCHOOL  MEDICAL   SERVICE      229 

Among  a  host  of  other  tests  of  efficiency  of  this  work  are  the 
following : 

(i)  Number  of  physicians  and  nurses  in  proportion  to  the 
school  population,  and  the  number  of  nurses  in  relation  to 
the  number  of  physicians. 

(2)  The  quahlications  and  the  character  of  the  super- 
vision of  these  ofhcials. 

(3)  The  percentage  of  the  school  population  inspected  and 
examined,  and  the  frequency  of  these. 

(4)  The  quality  of  the  reporting  system,  whether  it  em- 
phasizes essentials,  and  whether  it  promotes  accurate  records 
with  minimum  loss  of  time  from  other  work. 

(5)  The  annual  number  of  hours  of  work  for  physicians 
and  nurses,  and  the  regularity  and  punctuaHty  of  attendance 
upon  such  work. 

(6)  The  reasonable  freedom  from  epidemics,  closing  of 
schools,  deaths  of  school-children,  amount  of  exclusion,  quaran- 
tine, illness,  absence  and  ehmination,  etc. 

(7)  The  quahty  of  the  methods  of  doctors  and  nurses,  to 
be  determined  by  expert  observation. 

(8)  The  amount  of  State-aid  money  obtained  because  of 
efficiency  demonstrated  to  the  State  Supervisor  of  Hygiene. 

Note. — Complete  explanation  of  this  plan  of  health  supervision  may  be 
found  in  the  editor's  volume  entitled,  "The  Administration  of  School  Medical 
Inspection,"  published  by  Teachers  College,  Columbia  University,  New  York 
City. 


CHAPTER  XIII 
THE  SCHOOL  NURSE  AND  HER  WORK  i 

The  Introduction  of  Nurses. — It  was  the  introduction  of 
the  trained  nurse  to  the  work  of  school  medical  inspection 
that  revolutionized  the  health  supervision  of  school-children. 

In  England,  in  1893,  we  have  the  first  definite  record  of 
the  work  of  the  school  nurse.  This  work  was  done  voluntarily 
by  Miss  Amy  Hughes,  a  member  of  the  MetropoHtan  Associa- 
tion of  Nursing,  who  was  asked  by  one  of  the  managers  of  a 
poor  school  in  the  Drury  Lane  district  in  London  to  visit  the 
school  and  attend  to  the  children's  small  ailments.  The  result 
was  most  beneficial.  In  1898  a  voluntary  association  was 
formed,  called  the  London  School  Nurses'  Society.  The 
following  circular  was  prepared  and  issued  by  it: 

The  London  School  Nurses'  Society  has  been  formed  with  the 
object  of  supplying  visiting  nursing  to  elementary  schools  in  poor 
districts.  Already  three  nurses  visit  some  of  the  poorest  schools  and 
attend  to  the  small  ills  of  the  scholars — such  as  sore  heels  and  inflamed 
eyes. 

Excellent  results  follow  their  ministrations:  each  is  able  to  visit 
four  schools  in  one  day,  and  see  about  one  hundred  children,  who  are 
sent  to  her  one  by  one  by  the  teachers.  It  is  hoped  that  the  work  of 
the  London  School  Nurses'  Society  may  be  done  wherever  possible  by 
a  Queen's  nurse,  and  so  avoid  the  multiplying  of  agencies.  The 
Jubilee  Institute  has  approved  of  school  nurses  in  principle.  Probably 
it  will  be  difficult  to  impress  on  the  public  the  importance  of  the  work 
to  be  done,  or  the  necessity  for  these  nurses;  but  it  must  be  remem- 
bered that  the  sore  heel  soon  becomes  poisoned  if  left  to  London  dirt, 
and  the  inflamed  eyes  often  lose  all  power  of  seeing  simply  through 
neglect.  There  is  no  surer  way  of  securing  the  health  of  the  people 
than  to  arrest  small  ills  at  the  beginning;  a  nurse  can  see  at  a  glance 

"  See  also  the  chapter  on  "The  Professional  Training  of  Schcx)l-Health 
Workers." 

230 


THE    SCHOOL  NURSE   AND   HER  WORK  23 1 

whether  a  child  should  be  sent  to  a  doctor;  she  can  impress  cleanli- 
ness; she  can  follow  up  bad  cases  to  their  homes;  she  can  recognize 
the  early  symptoms  of  fevers,  and  do  much  to  stop  the  spread  of  those 
infectious  diseases  which  so  often  devastate  our  schools.  It  is  found 
that  cases  of  bad  eyes  and  dirty  heads  are  practically  stamped  out 
of  a  school  by  six  months'  regular  visiting;  consequently  each  nurse  is 
able  to  enlarge  the  scope  of  her  work  as  time  goes  on. 

In  1904  the  London  county  council  took  over  the  work, 
thus  placing  it  under  municipal  control.  But  it  was  in  1902 
that  school  nursing  was  first  put  on  a  municipal  basis,  and 
New  York  City  claims  the  credit  for  this  forward  step. 

New  York  City  History. — Medical  inspection  of  schools 
had  been  estabHshed  for  many  decades  before  this,  but  the 
results  were  far  from  satisfactory.  The  history  of  school 
nurses  in  New  York  City  is  particularly  interesting,  inasmuch 
as  those  who  suggested  and  helped  to  work  out  the  scheme 
of  school  nursing  are  still  actively  engaged. 

The  suggestion  came  from  Miss  Lillian  D.  Wald,  who  was 
talking  over  the  health  problem  of  the  schools  with  Doctor 
Lederle,  Health  Commissioner  of  New  York  City,  and  Mr. 
Charles  BurHngham,  chairman  of  the  Board  of  Education. 
The  question  under  discussion  was:  "What  is  to  be  done  with 
all  the  children  who  are  excluded  from  school  for  minor  con- 
tagious diseases  by  the  medical  inspectors?"  Miss  Wald  at 
once  said:  "Try  a  nurse."  She  herself  is  a  nurse  and  always 
sees  the  great  possibilities  in  new  opportunities;  so,  after  some 
further  discussion,  it  was  decided  to  see  what  a  nurse  could  do 
for  the  children  in  the  schools,  and  for  the  return  of  those 
who  were  excluded.  The  writer  was  asked  to  make  the  ex- 
periment, and  on  September  i,  1902,  began  by  selecting  for 
test  purposes  four  of  the  large  down- town  schools.^ 

First  Duties. — The  first  duty  was  to  visit  the  school  prin- 
cipals and  explain  the  work.  As  no  rooms  were  available, 
any  corner  of  the  schools  which  could  be  utilized  was  selected. 

*  Thus  the  writer  of  the  chapter  has  the  honor  of  being  the  first  municipal 
school  nurse. — Ed. 


232  EDUCATIONAL  HYGIENE 

Arrangements  were  made  to  have  all  children  examined  b}- 
the  medical  inspector  sent  to  the  nurse,  who  treated  the 
minor  cases  in  the  school;  the  remainder  were  taken  to  dis- 
pensaries, except  those  who  were  excluded  for  the  major  con- 
tagious diseases,  such  as  scarlet  fever,  measles,  etc.  A  list 
of  the  children  excluded  was  obtained  from  the  principal, 
and  these  were  looked  up  and  returned  to  school  as  soon  as 
possible.  An  hour  daily  was  spent  in  each  of  the  four  schools, 
and  a  regular  time-table  followed.  The  suppUes  used  were 
generously  donated  by  the  Nurses'  Settlement.  A  course  of 
treatment  was  outlined  and  submitted  to  the  Department  of 
Health,  which  with  a  few  revisions  is  in  use  at  the  present 
time.     This  course  of  treatment  is  about  as  follows: 

Treatment. 

Pediculosis. — Saturate  head  and  hair  with  equal  parts  of  kerosene 
and  sweet  oil;  next  day  wash  with  a  solution  of  potassium  carbonate 
(one  teaspoonful  to  one  quart  of  water),  followed  by  soap  and  water. 
To  remove  "nits"  saturate  hair  with  hot  vinegar. 

Favus,  Ringworm  of  Scalp. — Mild  cases:  Scrub  with  tincture  of 
green  soap,  cover  with  flexible  collodion.  Severe  cases:  Scrub  with 
tincture  of  green  soap,  epilate,  paint  with  tincture  of  iodine,  and  cover 
with  flexible  collodion. 

Ringworm  of  Face  and  Body. — Wash  with  tincture  of  green  soap 
and  cover  with  flexible  collodion. 

Scabies. — Scrub  with  tincture  of  green  soap,  apply  sulphur  oint- 
ment. 

Impetigo. — Remove  crusts  with  tincture  of  green  soap,  apply  white 
precipitate  ointment  {ting,  ammon.  hydrarg.). 

Molluscum  Contagiosum. — Express  contents,  apply  tincture  of 
iodine  on  cotton  toothpick  probe. 

Conjunctivitis. — Irrigate  with  solution  of  boric  acid. 

Supplies. — Later  the  Board  of  Education  provided  the 
following  supplies: 

1  screen. 

2  chairs  (i  high). 
I  cabinet. 

I  table. 


THE    SCHOOL  NURSE   AND   HER  WORK  233 

1  scrap-basket. 
12  towels. 

2  pounds  absorbent  gauze. 
I  dozen  bandages  (assorted  sizes). 
I  pound  boracic-acid  powder. 
I  quart  tincture  of  green  soap. 
4  ounces  collodion. 

1  pound  vaseline. 
4  ounces  white-precipitate  ointment. 

2  basins  (white  granite). 
I  glass  jar  (i  gallon). 
I  ointment  jar  (glass). 
100  bichloride-mercury  tablets  (to  be  kept  in  safe  place). 

These  were  ordered  by  the  principals  with  the  other 
regular  school  supplies  and  replenished  when  necessary. 

Municipal  Appointment. — On  November  7,  1902,  the 
Board  of  Health  appointed  its  first  school  nurse,  Miss  Lina 
L.  Rogers,  R.N.  In  December  of  the  same  year  twelve 
nurses  were  appointed,  and  their  work  for  one  month  proved 
of  such  value  to  the  community  that  the  Board  of  Estimate 
appropriated  $30,000  for  school  nurses  for  the  year  1903. 
This  is  the  beginning  of  what  has  developed  into  one  of  the 
most  efficient  social  service  organizations  of  the  present  day — 
three  hundred  and  sixty-five  school  nurses  being  now  employed 
by  the  Board  of  Health  of  New  York  City. 

Growth  of  Nurses'  Work. — In  the  beginning  of  the  work 
the  nurses'  duties  were  limited  to  treating  the  children  ex- 
cluded by  the  medical  inspector  and  to  making  home  calls  to 
explain  what  treatment  was  required  for  the  excluded  child. 

Later  on  classroom  inspections  were  added  to  the  nurses' 
duties,  giving  the  medical  inspectors  more  time  for  the  phys- 
ical examinations.  The  opportunities  for  far-reaching  social 
service  became  evident  on  the  first  visits  to  the  homes. 

Classroom  Inspection. — In  making  the  classroom  in- 
spection the  nurse  took  her  position  by  a  window  so  that  she 
might  have  a  good  hght  for  the  inspection  of  the  child.  The 
eyes,  ears,  nose,  throat,  skin,  and  hair  were  all  examined  for 


234  EDUCATIONAL  HYGIENE 

evidences  of  disease  or  defect.  Wooden  tongue  depressors 
were  used  for  examining  the  throat,  one  for  each  child,  and 
where  any  symptom  of  diphtheria  was  found  the  child  was 
sent  home.  Where  any  defect  was  present  the  children  were 
referred  to  the  medical  inspector.  His  duty  was  to  make  a 
diagnosis.  A  code  was  devised  by  which  numbers  could  be 
used  instead  of  the  name  of  the  disease,  to  conceal  from  chil- 
dren the  name  of  the  disease,  and  to  lessen  the  clerical  work. 


Code  Used. 


CODEi 


ly.   ravus. 

20.  MoUuscum  contagiosum. 

21.  Acute  coryza. 


1.  Diphtheria,  12.  Varicella. 

2.  Pediculosis.  13.  Pertussis. 

3.  Tonsihtis.  14.  Mumps. 

4.  Pediculosis.  15.  Zero. 

5.  Ac.  conjunctivitis.  16.  Scabies. 

6.  Pediculosis.  17.  Ringworm. 

7.  Trachoma.  18.  Impetigo. 

8.  Pediculosis.  19.  Favus. 

9.  Zero. 

10.  Scarlet  fever. 

11.  Measles. 

Zero  numbers  are  given  to  children  having  no  disease', 
so  that  all  should  be  given  a  code  number.  No  feelings  were 
hurt  by  the  method. 

Home  Visits. — The  nurse  took  charge  of  the  child  after 
the  diagnosis,  and  by  persistent  effort  and  many  visits  to 
the  home,  finally  persuaded  the  parents  to  have  the  defect 
remedied  or  disease  treated.  It  is  this  following  up  and  point- 
ing out  the  danger  of  neglect  that  means  so  much  to  the  child 
and  to  the  success  of  school  medical  inspection.  The  whole 
aspect  of  the  school  medical  work  has  changed  since  nurses 
have  taken  such  a  prominent  part  in  it.  It  is  no  longer 
medical  inspection  of  schools.  It  is  medical  or  health  super- 
vision of  school-children.  The  child  has  a  future,  and  some 
one  must  in  dead  earnest  point  it  out  to  the  parents  who  fail 
or  refuse  to  see  it. 

"  See  also  code  in  preceding  chapter,  prepared  by  the  editor. 


THE    SCHOOL  NURSE   AND   HER   WORK  235 

School  Boards'  Duty. — Right  here  it  may  be  said  that  some 
boards  of  education  are  not  doing  their  full  duty  toward  the 
children  under  their  charge,  by  forcing  them  to  study  while 
they  are  physically  unfit.  Where  now  employed,  the  school 
nurse's  duties  are  numerous  and  varied.  Besides  making  the 
classroom  inspections  and  referring  the  cases  to  the  medical 
inspector  she  is  called  upon  to  do  much  of  the  scientific  work. 
In  some  cities  the  school  nurse  takes  the  swabs  for  throat 
cultures,  and  excludes  all  suspect  cases  of  diphtheria,  scarlet 
fever,  measles,  etc.,  as  soon  as  discovered,  notifying  the 
medical  inspector  of  such  exclusion  as  well  as  the  health  de- 
partment. She  is  also  permitted  to  treat  eye  diseases  in  school 
according  to  the  physician's  order. 

Drills. — She  is  responsible  for  the  conditions  of  cleanli- 
ness of  the  mouths  of  the  school-children  as  well  as  their 
general  cleanliness.  Tooth-brush  drills  are  carried  on  regu- 
larly and  efficiently  in  the  schools  by  the  nurse.  Nose-blowing 
drills  are  no  longer  a  fad  but  a  recognized  necessary  aid  to 
general  health  habits,  and  the  nurse  is  the  one  who  sees  that 
this  is  regularly  carried  out.  It  was  a  nurse  who  originated 
these  drills  in  the  schools.^  Even  now  we  are  learning  that 
this  has  a  very  marked  effect  on  the  breathing  of  the  children, 
inculcates  cleanly  habits,  and  keeps  the  air  in  the  classroom 
purer.  Teachers  are  beginning  to  see  the  valuable  effect  of 
it  on  their  own  health. 

In  the  \dsits  to  the  homes  even  greater  good  is  being 
done  by  the  school  nurse.  Here  she  imparts  instruction  on 
the  care  of  the  body,  the  value  of  clean  surroundings,  of 
wholesome  food,  of  proper  clothing,  and  of  right  habits  of 
liN-ing.  She  discovers  all  kinds  of  imhealthful  conditions, 
concealed  cases  of  contagious  disease,  rooms  without  air  or 
light,  overcrowded  homes  where  bad  moral  conditions  exist, 
filthy  drains,  and  leaky  plumbing.  These  and  other  conditions 
are  being  constantly  reported  by  the  school  nurse  to  the 
proper  authorities,  and  adequate  rehef  obtained  from  the 
proper  sources. 

'  The  writer  herself. — Ed. 


236  EDUCATIONAL  HYGIENE 

Rural  School  Nursing. — In  rural  communities  health 
supervision  of  school-children  is  quite  as  important  as  in  the 
cities.  It  is  not  possible  for  many  of  the  smaller  municipal- 
ities to  provide  a  medical  inspector,  nor  is  it  always  necessary. 
If  a  properly  qualified  nurse  is  employed  she  can  urge  the 
parents  to  consult  their  own  family  physicians,  and  in  this 
way  have  almost  all  defects  removed  or  diseases  cured.  It 
will  not  be  necessary  for  one  school  to  have  a  nurse  devote 
her  whole  time  to  it.  Several  districts  could  unite  and  have 
the  nurse  spend  one  day  a  week  in  each.  This  would  divide 
expenses  and  give  a  good  service.  Each  school  should  be 
visited  frequently  to  note  progress,  to  urge  the  practise  of 
hygienic  measures  advised,  such  as  the  drills,  and  to  give 
talks  on  proper  food,  ventilation,  dental  care,  etc. 

Relief  Organizations.— One  of  the  school  nurse's  duties 
will  be  to  find  out  all  the  relief  agencies  in  her  district  or  dis- 
tricts. If  there  is  no  dispensary,  she  will  be  the  one  to  find 
ways  and  means  to  estabhsh  one.  If  the  authorities  cannot 
aid,  some  influential  women  in  the  neighborhood  should  be 
induced  to  unite  and  have  it  started.  If  relief  is  required, 
similar  means  are  taken  to  secure  it.  Everything,  of  course, 
should  be  done  so  far  as  possible  by  the  municipal  authorities. 

I  believe  that  the  school  board  should  furnish  freely  every- 
thing that  is  necessary  for  the  child's  health  and  strength, 
such  as  food,  clothes,  and  medical  attention, .  wherever  it 
cannot  be  furnished  by  the  home.  Otherwise  it  is  waste  of 
money  to  try  to  educate  the  child.  A  weakened  brain  cannot 
be  active  and  receptive;  therefore  strengthen  it  so  that  it  can. 
Children  who  are  anemic  and  undersized  should  be  kept  in 
the  open.  The  school  nurse  should  urge  that  children  be 
taught  in  the  open  all  day  in  country  schools  as  well  as  the 
•city,  and  what  is  good  for  the  delicate  in  this  instance  is 
equally  good  for  the  strong.  Let  us  have  no  walls  for  schools 
when  it  is  possible  to  do  without. 

Little  Mothers'  Classes. — The  school  nurse  also  should 
start  little  mothers'  classes  in  the  gchool  as  soon  as  she  begins 


THE   SCHOOL  NURSE   AND   HER   WORK  237 

work.  Inestimable  good  will  be  done  by  having  these  girls 
taught  how  to  do  the  essentials  of  home-making.  Gradually 
they  grow  into  the  habit  of  wanting  to  know  the  reasons  for 
this  and  that,  and  before  long  the  nurse  finds  she  is  a  teacher 
in  sex  hygiene  in  the  most  natural  way.  Teach  the  girls  to 
bring  their  baby  sisters  and  brothers,  so  that  they  may  learn 
how  to  bathe  them  and  note  any  abnormalities;  show  them 
how  to  make  a  bed  properly;  to  prepare  food  for  the  baby; 
to  make  clothes  for  it;  and  to  look  for  any  unusual  conditions 
in  the  children  of  the  families  who  are  their  friends. 

School  Dental  Chairs. — Here  is  the  beginning  of  a  great 
work  in  the  development  of  the  future  race,  in  looking  after  the 
teeth.  The  "little  mothers"  will  soon  learn  to  look  for  the 
first  tooth,  and  to  keep  it  clean.  If  this  interest  is  aroused 
and  right  habits  formed  we  shall  not  need  to  fear  for  the  future 
of  the  children's  teeth. 

It  is  very  necessary  that  all  the  school-children  have 
regular,  systematic  dental  care.  To  this  end,  wherever  possi- 
ble, have  a  dental  chair  placed  in  the  school.  Experience  has 
proved  that  the  installation  of  dental  chairs  in  the  schools  is 
not  a  difficult  undertaking  and  is  money  saved  many  times 
over. 

In  Toronto,  Canada,  the  school  nurses  subscribed  $500 
and  presented  it  to  the  Board  of  Education  for  the  equipment 
of  a  dental  room  in  one  of  its  schools.  In  addition  the  Board 
installed  three  chairs  in  other  schools.  This  year  six  more 
schools  have  been  equipped  with  dental  chairs.  A  dental 
surgeon  works  from  nine  to  twelve  daily,  and  on  Saturday 
from  nine  to  eleven.  Many  methods  may  be  used  to  get  the 
money  and  permission  for  the  first  experiments.^ 

The  Qualifications  of  a  School  Nurse. — The  nurse  who 
would  be  a  successful  school  nurse  must  have  a  special  train- 
ing for  the  work.  In  addition  to  the  general  training  in  a 
hospital  which  has  wards  set  apart  for  eye,  ear,  nose,  throat, 
and  skin  diseases,  she  should  have  a  course  in  district  nursing. 

*  See  chapters  on  co-operation  and  initiation  of  school-health  measures. 


238  EDUCATIONAL  HYGIENE 

This  is  most  important,  as  it  brings  the  nurse  in  contact  with 
home  conditions.  Here  she  learns  how  it  is  sometimes  next 
to  impossible  for  the  parents  to  get  things  done,  owing  to  all 
sorts  of  unfortunate  conditions. 

A  capable,  intelligent  nurse  who  knows  the  agencies  in 
her  district  can  often  relieve  serious  situations  at  once  by  a 
few  helpful  suggestions  as  to  how  reHef  may  be  obtained. 
The  school  nurse  should  have  a  healthy,  pleasant  appearance. 
The  nurse  who  fails  to  keep  herself  tidy  and  neat,  and  whose 
teeth  are  not  in  good  condition,  does  not  gain  the  confidence 
of  the  children,  and  her  work  is  never  successful. 

The  school  nurse  should  have   a  broad  social  outlook. 
She  must  be  a  power  in  the  community  in  which  she  works.  ^ 
She  must  know  how  to  meet  rich  and  poor  alike,  and  this  is| 
where  tact,  good  sense,   and  sound  judgment  are  required. 
She  must  know  how  to  avoid  hurting  the  feelings  of  the  family] 
physician. 

The  most  essential  requirement  is  thoroughness.  Everj 
detail  should  be  recorded  for  future  use — some  may  be  mental 
notes.  One  nurse  reported  ninety-nine  visits  to  one  family 
before  she  got  results.^ 

Controlling  Authority. — The  school  nurse  should  be  em- 
ployed by  the  board  of  education  or  board  of  school  trustees 
as  one  of  the  regular  school  staff.  This  avoids  two  authorities 
controlling  the  school  work.  The  teachers  give  heartier  co- 
operation to  one  of  their  own  associates,  and  all  are  working 
ultimately  for  the  same  result — to  make  the  school-child  a 
better  citizen  both  physically  and  mentally.  This  has  been 
clearly  demonstrated  since  the  school  nurses  became  a  part 
of  the  medical-inspection  system. 

Rules  and  Regulations. — In  one  of  the  larger  cities  the 
following  general  rules  and  duties  of  nurses  have  been  adopted : 

'  Here  is  where  legal  compulsion  can  frequently  be  used  to  advantage. — Ed. 


The  school  nurse  in  the  home,  Boston  Public-School  Hygiene  Department 


THE    SCHOOL  NURSE   AND   HER   WORK  239 


GENERAL  RULES 

As  teachers,  nurses,  and  medical  and  dental  inspectors  are  all  em- 
ployed by  the  board  of  education,  and  as  all  are  working  for  the  fullest 
development  of  the  children,  educationally  and  physically,  it  should 
not  be  necessary  to  ask  for  hearty  and  harmonious  co-operation  in  the 
work. 

Always  be  courteous  and  sympathetic  with  parents  and  children, 
and  thus  avoid  much  needless  resentment. 

Absolutely  no  suggestions  as  to  treatment  shall  be  given  except 
as  hereinafter  directed. 

Medical  inspectors  and  nurses  must  promptly  report  all  dis- 
covered cases  of  contagious  disease  to  the  board  of  health,  thus  ren- 
dering efficient  assistance  in  eliminating  this  menace  to  the  community. 

The  following  diseases  must  be  referred  to  the  principals  for  ex- 
clusion: smallpox,  scarlet  fever,  diphtheria,  measles,  German  measles, 
mumps,  chicken-pox,  acute  tonsilitis,  whooping-cough,  open  cases  of 
tuberculosis,  and  such  diseases  of  skin,  scalp,  and  eye  as,  in  the  judg- 
ment of  the  medical  inspector,  should  be  excluded. 

Except  in  case  of  sudden  illness,  request  for  leave  of  absence 
must  be  forwarded  to  the  department  of  medical  inspection  at  least 
one  week  before  such  leave  is  required.  In  case  of  inability  to  report 
for  duty  on  account  of  illness,  notify  the  department  of  medical  in- 
spection by  telephone. 

A  written  notification  must  follow  within  twenty-four  hours. 
When  reporting  for  duty  after  absence,  a  certificate  of  illness  from  the 
attending  physician  must  be  presented. 

Daily  reports  must  be  forwarded  in  time  to  reach  the  department 
of  medical  inspection  by  the  first  mail  on  the  following  morning. 

At  each  school  visited,  a  time-book  must  be  signed,  stating  the 
time  of  arrival  and  departure.  All  cases  requiring  treatment  must  be 
referred  by  card,  in  sealed  envelope,  to  the  family  physician.  Medical 
inspectors  and  nurses  must  not  remove  the  clothing  for  examination 
of  children,  "  without  consent ''  or  in  the  presence  of  parent  or  guardian. 
Medical  inspectors  and  nurses  must  not  interfere  in  any  way  with 
the  school  discipline. 

Duties  of  Nurses 

Each  nurse  is  assigned  to  a  group  of  schools. 
The  hours  of  duty  are  from  q  a.  m.  to  4  p.  M.,  and  Saturday,  9  A.  M. 
to  12  noon. 

Each  nurse  shall  prepare  a  time  schedule  for  her  group  of  schools 


240  EDUCATIONAL  HYGIENE 

which  must  be  forwarded  to  the  superintendent  of  nurses  for  approval; 
a  copy  must  be  given  to  each  principal. 

Each  nurse  must  see  cases  referred  to  her  by  the  medical  inspector 
and  deal  with  them  as  directed. 

Morning  Inspections  and  Treatments. — In  a  room  designated  for 
the  purpose  the  nurse  must  receive  each  morning  all  children  referred 
to  her  by  the  medical  inspector,  and  give  instructions  or  treatment  as 
follows: 

Pediculosis. — Children  affected  with  pediculosis  are  to  be  instructed 
as  to  methods  of  home  treatment.  Each  child  must  be  given  a  copy  of 
the  official  circular,  entitled  "Instructions  to  Parents  on  the  Care  of 
Children's  Hair  and  Scalp."  These  children  are  to  be  instructed  to 
report  to  the  nurse  at  her  request,  and  at  such  times  are  to  be  exam- 
ined for  evidence  of  treatment.  In  instances  of  persistent  neglect,  the 
child  is  to  be  referred  to  the  medical  inspector  for  exclusion. 

Eye  and  Skin  Diseases. — Methods  of  treatment  to  be  employed. 

Favus. ^Mild  cases:  scrub  with  tincture  of  green  soap  and  cover 
with  flexible  collodion.  Severe  cases:  scrub  with  tincture  of  green 
soap,  paint  with  tincture  of  iodine,  and  cover  with  flexible  collodion. 

Ringworm  of  Scalp. — Treatment  as  in  favus. 

Ringworm  of  Face  and  Body. — Wash  with  tincture  of  green  soap 
and  cover  with  flexible  collodion. 

Scabies. — Wash  with  tincture  of  green  soap,  and  apply  sulphur 
ointment. 

Impetigo. — Remove  crusts  with  tincture  of  green  soap,  and  apply 
white-precipitate  ointment  (ammon.  hydrarg.),  lo  per  cent. 

Conjunctivitis. — Irrigate  with  warm  solution  of  boric  acid. 

Instructions  for  Physical  Defects. — The  nurse  must  obtain  each  day 
from  the  medical  inspector  a  record  of  the  physical  defects  of  each  case 
examined  on  that  day.  When  necessary  the  nurse  may  request  the 
parents  to  confer  with  her  at  the  school  regarding  the  treatment  for 
the  child. 

The  dates  of  these  consultations  must  be  noted  on  the  nurse's 
record  copy.  The  nurse  will  note  on  the  physical-record  card  the 
nature  of  the  treatment  received  from  the  family  physician. 

Emergency  Cases. — In  the  absence  of  the  medical  inspector  the 
nurse  will  give  first-aid  treatment,  referring  all  such  cases  as  require 
it  to  the  family  physician.  In  the  absence  of  the  medical  inspector 
any  suspected  case  of  major  contagious  disease  should  be  referred 
to  the  principal  for  exclusion,  and  should  be  reported  immediately 
by  telephone  to  the  department  of  medical  inspection,  giving  child's 
name  and  address.    A  written  report  must  be  mailed  the  same  day. 

The  nurse  must  be  ready  to  give  any  information  to  the  principal 


THE    SCHOOL   NURSE   AND   HER   WORK  24 1 

as  to  the  children  under  her  care.  A  child  must  not  be  sent  from 
school  without  the  consent  of  the  principal. 

Routine  Inspection. — The  nurse  must  make  a  fortnightly  routine 
inspection  of  the  children  in  the  classrooms.  The  eyelids,  throat, 
skin,  and  hair  of  each  pupil  are  to  be  examined. 

The  children  are  to  be  instructed  to  pull  down  the  eyelids,  open 
the  mouth,  and  show  the  hands.  Wooden  tongue  depressors  are 
furnished  by  the  department,  and  a  separate  one  must  be  used  for 
each  child  where  such  use  is  necessary.  No  tongue  depressor  is  to  be 
used  more  than  once  under  any  circumstances. 

All  cases  of  suspected  minor  contagious  disease  found  are  to  be 
noted  on  the  class  record  cards,  with  the  data,  in  appropriate  columns. 

The  class  record  cards  must  be  kept  in  an  accessible  place  in  each 
school  in  charge  of  the  nurse.  Code  numbers  or  letters  must  be  used 
to  indicate  the  disease. 

All  suspected  cases  of  contagious  eye  and  skin  disease  found  are 
to  be  referred  to  the  medical  inspector  for  diagnosis. 

Home  F15//5.— When  cases  referred  by  the  medical  inspector 
have  not  been  given  treatment  in  a  reasonable  time,  the  nurse  must 
visit  the  parents  at  home  to  explain  the  condition  and  the  necessity 
for  treatment.  The  nurse  must  give  general  directions  regarding 
proper  food,  ventilations,  cleanliness,  and  general  hygiene.  Revisits 
must  be  made  in  each  instance  until  evidence  of  treatment  is  shown, 
or  parents  refuse  treatment.  No  case  must  be  terminated  on  account 
of  inability  to  obtain  treatment  until  it  has  been  referred  to  the 
medical  inspector. 

If  the  parents  are  unable  to  take  the  child  to  a  dispensary,  the 
nurse  may  do  so,  but  must  previously  obtain  in  writing  a  request  to 
that  effect,  signed  by  the  parent  or  guardian. 

No  visit  shall  be  made  to  contagious  cases. 

Home  visits  and  visits  to  hospital  or  dispensary  must  be  noted  on 
the  nurse's  record  copy.  The  form  must  then  be  submitted  to  the 
medical  inspector,  who  will  sign  it  if  the  evidence  is  satisfactory. 

Evidence  that  a  child  is  under  medical  care  is  sufficient  for  ter- 
minating the  case. 

Meetings. — Nurses  must  report  regularly,  in  person,  at  such  times 
as  may  be  designated,  to  the  superintendent  of  nurses. 

In  Conclusion. — The  possibilities  of  the  work  of  the  school 
nurse  and  the  opportunities  afforded  her  of  doing  real  con- 
structive work,  both  in  the  schools  and  in  the  homes,  cannot 
be  estimated.     The  bond  of  friendship  which  exists  between 


242  EDUCATIONAL  HYGIENE 

the  school  nurse  and  the  mother  in  the  home  makes  it  pos- 
sible to  secure  for  the  children  from  infancy  onward  a  far 
greater  degree  of  care  than  would,  or  could,  otherwise  be 
given.  The  school  nurse  has  it  in  her  power  not  only  to 
remedy  the  existing  conditions  which  are  menaces  to  right 
living  but  has  also  the  opportunity  to  open  up  new  avenues 
of  social  service.  Her  work  is  not  alone  with  those  who  have 
defects  or  disease  but  very  largely  with  those  who  are  well. 
Her  duty  will  become  more  and  more  the  supervision  of  the 
life  habits  of  the  well;  therefore  much  more  teaching  of  the 
laws  of  health  will  be  observed  and  the  result  to  humanity 
can  better  be  imagined  than  described.  Nurses  have  a  splen- 
did opportunity  for  fitting  themselves  for  this  new  field  in 
nursing  by  taking  a  course  at  Teachers  College,  Columbia 
University,  where  the  practical  training  is  also  provided. 


CHAPTER  XIV 
PUBLIC  SCHOOL  CLINICS 

Health  Supervision  Beginnings. — Health  supervision,  like 
public  education,  was  first  established  as  a  means  of  relief  for 
the  poor.  Subsequently,  Hke  public  education,  it  became  free, 
democratic,  and  even  respectable.  It  now  remains  for  health 
supervision  to  enter  the  third  stage  of  its  development  and  to 
become  not  only  free  but  compulsory. 

In  its  first  stages,  health  supervision  has  emphasized  in- 
spection, description,  and  recommendation  as  the  appropriate 
means  for  locating  physical  defects  and  securing  the  co-opera- 
tion of  parents  and  physicians  in  their  treatment.  In  its 
final,  compulsory  stage  it  must  inevitably  place  the  emphasis 
upon  constructive  measures  and  provide  the  facihties  for 
making  its  authority  effective.  The  relief  and  prevention  of 
physical  defects,  through  adequate  treatment  on  the  one 
hand  and  effective  control  of  causes  on  the  other,  will  be  the 
primary  function  of  health  supervision;  medical  inspection  be- 
ing only  an  introductory  and  incidental  step  toward  a  com- 
prehensive programme  of  physical  education,  medical  and  den- 
tal treatment  as  needed,  and  training  in  hygienic  and  sanitary 
habits,  that  will  be  carried  out  with  each  pupil  through 
every  day  of  school  hfe. 

The  Problem  of  Treatment. — The  greatest  difficulty  in 
executing  so  broad  a  health  programme  lies  in  securing  the 
necessary  medical  and  dental  treatment;  and  this  problem 
is  undoubtedly  the  most  pressing  one  relating  to  the  health 
of  school-children  to-day.  In  time  we  may  develop  such 
sanitary  schools  and  such  wholesome  courses  of  study,  and 
educate  both  parents  and  pupils  so  successfully  in  the  prin- 

243 


244 


EDUCATIONAL  HYGIENE 


ciples  and  practise  of  hygiene,  that  the  defects  and  ailments 
of  school-children  will  cease  to  exist.  Until  that  time,  however, 
the  children  who  are  handicapped  and  suffering  must  be 
helped;  and  it  is  gradually  becoming  evident  that  the  surest, 
most  effective,  and  most  economical  way  of  doing  this  is 
through  the  school  clinic. 

The  school  clinic  has  only  recently  come  into  existence, 
the  term  being  applied  to  any  dispensary  that  is  conducted 
for  school-children.  Five  or  six  years  ago  the  term  was 
generally  understood  to  mean  a  dental  dispensary  for  school- 
children. This  is  still  the  case  almost  everywhere  except  in 
Great  Britain.  The  term  polyclinic  is  often  used  to  indicate 
a  dispensary  where  various  kinds  of  cases  are  treated,  but 
the  simpler  term  is  gaining  in  favor,  and  in  time  a  school  clinic 
will  be  understood  to  be  a  place  where  school-children  can 
receive  any  form  of  treatment  that  does  not  require  them  to 
remain  in  bed.  Los  Angeles  has  a  well-developed  cHnic  of 
this  sort.  It  occupies  an  entire  building,  which  is  equipped 
to  accommodate  various  kinds  of  cases  that  can  be  handled 
in  a  single  day.  Here  the  children's  eyes,  ears,  noses,  throats, 
and  teeth  are  treated,  and  circumcision  is  performed.  A 
second  building,  adjoining  the  clinic,  houses  a  carefully  con- 
ducted hospital  where  children  may  remain  as  long  as  neces- 
sary as  guests  of  the  Parent-Teachers  Association. 

School  clinics  in  this  country  are  still  comparatively  rare 
and  sporadic,  though  the  amount  of  publicity  given  to  the 
few  that  have  been  established  might  lead  the  unthinking 
to  believe  that  our  20,000,000  school-children  must  by  this 
time  be  fairly  well  provided  for.  We  have,  indeed,  made 
progress  since  1907,  when  the  New  York  Children's  Aid  Soci- 
ety opened  the  first  dental  clinic  in  this  country;  but  the  pro- 
portion of  dental  clinics  that  we  now  have  to  those  we  still 
need  may  safely  be  estimated  as  100  to  15,000.  Before  this 
discrepancy  can  be  much  reduced  the  American  people  must 
be  roused  to  the  point  of  demanding  medical  and  dental  treat- 
ment for  all  the  children  who  need  it,  and  of  understanding 


1 


PUBLIC-SCHOOL  CLINICS  245 

clearly  that  the  school  clinic  is  the  one  best  agency  for  meet- 
ing this  need. 

The  Facts  of  the  Case. — The  pubUc  demand  for  free  med- 
ical and  dental  service  will  assert  itself  just  as  fast  as  the  facts 
regarding  the  present  health  and  the  best  methods  of  treating 
school-children  become  generally  known.  The  facts  already 
well  established  are  briefly  as  follows: 

1 .  Six  to  eight  school-children  out  of  ten  need  during  any 
given  year  the  service  of  a  dentist  or  doctor. 

2.  More  than  70  per  cent  of  these  children  never  get  it. 

3.  Certain  progressive  school  systems  by  persistent  and 
costly  follow-up  work  and  by  pressing  into  their  service  all 
available  outside  agencies — public  dispensaries,  hospitals,  dis- 
trict physicians,  and  private  doctors — have  secured  treatment 
for  somewhat  more  than  half  tJie  children  who  need  it. 

4.  A  certain  amount  of  treatment  thus  secured  is  invari- 
ably worthless  or  even  harmful. 

5 .  Public  treatment  under  expert  management  is  the  only 
means  at  present  of  getting  reliable  service  for  100  per  cent 
of  the  school-children  who  need  it. 

6.  A  clinic  conducted  by  a  well-paid  expert  is  the  most 
economical  arrangement  for  giving  dental  or  medical  treat- 
ment, the  cost  per  treatment  being  only  a  small  fraction  of 
the  charge  that  would  be  made  for  a  similar  service  by  a  re- 
liable private  practitioner. 

7.  Giving  school-children  the  dental  and  medical  treat- 
ment they  need  increases  school  attendance  and  school  ef- 
ficiency, reduces  grade-repeaters,  and  saves  schooling  expense. 

8.  School  clinics,  in  or  near  schools,  have  three  notable 
advantages  over  any  other  kind  of  dispensary  open  to  chil- 
dren; namely: 

{a)  Promptness  and  convenience  of  suitable  treatment. 
{h)  Cultivation  of  helpful  relations  between  the  home  and 
school. 

(c)  Opportunities  for  health  education. 

These  three  advantages  will  be  discussed  in  turn. 


246  EDUCATIONAL  HYGIENE 

Promptness  and  Convenience  of  Suitable  Treatment. — 

The  value  of  the  promptness  and  convenience  in  medical 
service  as  rendered  by  the  school  clinic  can  hardly  be  over- 
estimated. Under  the  haphazard  method  of  sending  out 
children  to  get  treatment  if  they  can,  wherever  and  whenever 
they  can,  not  only  do  many  children  fail  to  receive  any  treat- 
ment or  get  it  too  late,  but  many  who  are  treated  meet  such 
unsuitable  handling  that  their  condition  is  as  bad  as  or  worse 
than  it  would  have  been  with  complete  neglect.  Even  when 
school-children  are  received  at  a  good  general  cUnic,  if  this 
happens  to  be  at  a  distance  from  home  or  school,  the  dififi- 
culty  of  travelling  back  and  forth  and  of  losing  further  time 
by  waiting  turns  at  the  clinic,  makes  it  practically  impossible 
for  all  the  children  to  receive  the  regular  and  frequent  treat- 
ments that  many  of  them  need. 

On  the  other  hand,  the  school  cHnic  which  is  in  or  near 
the  school  and  conducted  under  expert  control  has  the  best 
standards  and  appliances  for  treatment  available  for  all  the 
children  at  the  time  they  need  them.  This  makes  possible 
the  cure  of  many  chronic  ailments  which  otherwise  would 
receive  no  medical  attention  at  all  and  which  in  many  cases 
would  result  in  permanent  injury  to  the  children.  The  care- 
ful daily  treatment  of  running  ears,  inflamed  eyes,  ulcerated 
teeth,  and  certain  skin  diseases  can  be  easily  and  properly  ad- 
ministered in  the  school  clinic  and  hardly  through  any  other 
means.  Such  ailments,  moreover,  are  prevented  from  gain- 
ing the  headway  they  often  do  by  their  prompt  detection  and 
cure  in  the  school  clinic. 

The  promptness  and  convenience  of  school  treatment 
brings  as  marked  an  advantage  to  the  school  as  to  the  pupil 
in  its  direct  result  of  increasing  school  attendance.  For  in- 
stance, when  children  may  be  treated  at  school  for  minor 
contagious  ailments  they  need  not,  as  formerly,  be  excluded 
from  school  until  they  can  show  evidence  of  having  received 
satisfactory  treatment.  The  introduction  in  New  York  of 
prescribed  treatment  of  this  sort  by  school  nurses  reduced 


PUBLIC- SCHOOL  CLINICS  247 

the  number  of  exclusions  for  contagious  disease  from  57,000 
in  1903  to  slightly  over  3,000  in  191 1,  and  this  in  spite  of  the 
great  increase  in  the  number  of  school-children  in  that  time. 

Cultivation  of  Helpful  Relations  Between  the  Home  and 
School. — Any  agency  that  unites  school  authorities  and 
parents  in  their  common  task  of  developing  vigorous  citizens 
is  exceedingly  valuable.  The  school  cHnic  offers  unique  op- 
portunity for  such  a  relation;  allowing  nurses  and  doctors  to 
gain  the  friendly  intimacy  uith  school  famihes  that  in  some 
way  they  must  gain  before  they  can  hope  to  exert  effective 
influence  among  them.  Parents  who  see  their  children's 
health  improving  under  the  careful,  friendly  efforts  of  school 
officials  gain  a  new  confidence  in  the  pubUc  schools.  At  the 
same  time  they  gain  a  new  sense  of  the  value  of  health  and  the 
importance  of  cherishing  it  in  their  children;  the  result  being 
that  they  co-operate  cordially  with  the  work  of  the  clinic. 

While  directly  promoting  home  welfare,  the  close  per- 
sonal relations  possible  in  the  school  clinic  are  of  great  aid 
to  the  doctors  and  nurses  in  their  professional  work.  Chil- 
dren are  not  merely  "cases,"  as  they  are  likely  to  be  in  large 
public  dispensaries  without  social-service  departments.  In  a 
school  clinic  the  children  themselves  and  their  famihes  become 
the  objects  of  interest  and  care.  It  is  possible  to  follow  up 
the  life-history  of  each  child  and,  through  the  school,  to  keep 
him  constantly  under  observation.  This  continued  acquaint- 
ance with  the  children  and  their  families  ine\'itably  leads  to 
the  detection  and  correction  of  causes  of  ill  health  that  could 
never  be  discovered  under  the  impersonal  management  of  an 
ordinary  pubUc  dispensary. 

Opportunities  for  Health  Education  and  Research. — 
While  the  primary  purpose  of  the  school  cUnic  is  to  give 
treatment,  its  educational  possibilities  are  no  less  important. 
Its  very  existence  in  the  community  is  an  educational  force. 
Neither  children  nor  parents  can  visit  a  well-conducted  cUnic 
without  being  permanently  impressed  with  its  sanitary  and 
hygienic  standards.    Merely  to  see  one  dressing  performed  by 


248  EDUCATIONAL  HYGIENE 

surgically  clean  methods  and  to  observe  the  scrupulous  care 
that  is  taken  to  keep  the  entire  clinic  and  all  its  appliances 
dustless  and  spotless  are  object-lessons  worth  many  weeks  of 
theoretical  instruction. 

The  educational  influence  of  a  school  clinic  need  not,  of 
course,  be  limited  to  its  patients  and  their  famihes.  With 
an  expert  stafif  of  doctors  and  nurses  at  command,  it  can  and 
should  be  used  for  giving  frequent  demonstrations  and  ex- 
hibits as  a  means  of  interesting  the  entire  community  in  the 
fundamental  concerns  of  health. 

The  school  clinic  is  not  only  well  equipped  to  give  instruc- 
tion but  to  carry  on  research.  It  is  the  ideal  training-ground 
of  the  school  hygienist.  Such  study  of  the  life-history  of  in- 
dividual school-children  as  is  possible  in  a  school  clinic,  in 
addition  to  facihtating  greatly  the  treatment  of  individual 
cases,  may  readily  furnish  a  thoroughly  scientific  basis  for 
the  improvement  of  health  conditions  for  all  school-children 
and  ultimately  for  the  entire  community.  The  scientific  com- 
piling, interpretation,  and  use  of  records  is  a  twentieth- 
century  invention  not  yet  widely  incorporated  among  school 
systems;  and  thus  far  school  clinics,  both  at  home  and  abroad, 
have  shown  little  tendency  to  outstrip  the  schools  in  the  ap- 
plication of  statistical  methods.  The  number  and  kinds  of 
cases  treated  and  the  gross  cost  incurred  is  practically  all  the 
information  to  be  gained  from  the  records  of  many  very 
active  and  well-equipped  clinics. 

The  present  general  neglect  of  the  statistical  method  in 
conducting  school  clinics  is  reflected  in  Doctor  Cruickshank's 
otherwise  excellent  book  on  "School  Clinics  at  Home  and 
Abroad."  It  is  impossible  in  this  latest  and  most  extensive 
study  of  school  clinics  to  find  any  report  which  measures 
definitely  the  actual  effect  of  school  clinics  upon  the  health 
of  children.  The  nearest  approach  to  such  a  report  is  the 
general  statement  (p.  154)  that  "the  clinic  at  Freiburg  i.  B. 
has  been  at  work  for  some  years  with  the  result  that  less  and 
less  treatment  is  required  every  year." 


Dental  clinic,  opcraling-room,  Strasburg,  Germany 
The  first  school  dental  clinic 


OnlioiK'dic  clinic,  Dunfermline,  Scotland 
Treatment  of  spinal  cur\-ature 


PUBLIC-SCHOOL  CLINICS  249 

Neglect  of  statistical  method  is  perhaps  natural  during 
the  initial  years  of  school  clinics  when  much  energy  must 
necessarily  go  to  the  mere  starting  of  the  machinery,  but 
this  must  not  continue  if  the  school  clinic  is  to  become  more 
than  an  unregulated  machine. 

Whether  all  the  children  needing  treatment  are  receiving 
it;  how  many  who  have  been  treated  remain  well;  whether 
physical  defects  are  diminishing;  whether  the  general  health 
of  the  school-children  and  the  condition  of  their  teeth  is  better 
and  by  how  much,  since  the  school  clinic  began  work;  whether 
improved  school  work  follows  improved  health  and  to  what 
extent;  what  are  the  causes  of  ailments  treated  and  what  has 
been  done  to  remove  them — these  are  some  of  the  facts  that 
the  records  of  any  school  clinic  should  disclose  and  which 
some  of  the  more  progressive  clinics  are  already  recording. 
An  example  of  such  scientific  record-keeping  is  the  work  re- 
ported by  t^mma  Kohnky.  of  Cincinnati,  in  the  Journal  of 
Educational  Psychology,  December,  19 13.  In  the  Cincin- 
nati experiment  it  was  found  that  a  fifth-grade  class  of  forty 
children  who  received  all  necessary  dental  care  for  seven  months 
showed  in  four  out  of  five  psychological  tests  a  gain  over  an- 
other fifth-grade  class  of  the  same  number  and  the  same  gen- 
eral social  and  physical  condition  but  which  received  no  more 
dental  care  than  is  usual  with  school-children — that  is,  prac- 
tically none. 

Instructive  records  of  this  sort  will  gradually  become  the 
rule  as  the  organization  and  methods  of  school  clinics  become 
thoroughly  developed  and  standardized. 

School  Clinics  as  Research  Laboratories. — In  the  larger 
cities  the  possibilities  of  school  clinics  as  research  laboratories 
are  enormous.  They  may  easily  be  made  the  means  of  es- 
tablishing scientifically  the  effect  upon  health  of  school  and 
home  conditions,  such  as  protracted  desk  work,  length  of 
school  hours,  fresh-air  classes,  home  study,  length  of  noon 
intermission,  frequency  and  length  of  recesses,  number  of 
hours  of  sleep,  character  of  diet  and  ventilation,  and  a  score 


2SO 


EDUCATIONAL  HYGIENE 


of  Other  conditions  the  effects  of  which  are  still  conjectural. 
Having  once  established  such  facts,  school-health  authorities 
will  be  in  a  position  to  enforce  their  acceptance  as  guiding 
principles  in  the  entire  programme  of  the  school. 

Combining,  as  it  may,  a  scientific  method  and  a  close, 
constant  touch  with  the  people,  the  well-conducted  school 
clinic  will  probably  become  the  most  important  of  all  the 
agencies  that  make  for  the  nation's  health.  It  will  gradually 
outgrow  the  restricted  title  "school  cHnic"  and  be  known  by 
some  such  name  as  "public  health  centre";  for  the  emphasis 
in  time  will  be  shifted  from  the  curing  of  physical  ills  to  the 
conserving  and  developing  of  health,  and  the  school-child 
who  is  at  present  its  sole  beneficiary  will  share  its  benefits 
with  the  entire  family.  It  is  already  obvious  that  a  little 
tinkering  of  the  bodies  of  children  between  the  ages  of  six 
and  fourteen  will  not  make  an  entire  community  healthy. 
What  is  gained,  for  instance,  by  ridding  a  child  of  vermin  and 
sending  him  directly  back  to  an  infected  family;  or  what  be- 
lated treatment  can  help  a  child  of  six  whose  eyes  have  been 
made  useless  by  four  years  of  neglect  before  he  was  old  enough 
to  claim  the  advantage  of  the  school  clinic? 

The  foundation  of  bodily  vigor  rests  in  family  life.  The 
care  that  is  given  from  babyhood  on,  together  with  the  Hving 
conditions  of  the  home  and  the  sanitary  organization  and 
management  of  the  community,  are  the  real  determinants  of 
health.  It  is  these  factors  which  health  officials  must  control 
if  their  work  is  to  be  more  than  merely  patching  up  mistakes. 
The  pubHc  health  centre  into  which  the  school  chnic  will 
develop  will  have  its  child  nurses,  its  diet  experts,  neighbor- 
hood inspectors,  and  house  sanitarians  to  show  fathers  and 
mothers  how  to  keep  their  children  healthy  and  their  homes 
and  surroundings  sanitary. 

This  comprehensive  kind  of  health  education  which  will 
ultimately  be  connected  with  our  pubHc  schools  is  now  def- 
initely foreshadowed  in  various  forms  of  philanthropic  and 
pul^lic    enterprise.      Milk    stations,    diet  .kitchens,    creches, 


PUBLIC-SCHOOL   CLINICS  251 

municipal  nurses,  school  doctors,  school  nurses,  and  an  oc- 
casional school  clinic  are  doing,  here  and  there  for  a  few,  some 
of  the  work  that  public  health  centres  wdll  eventually  do  for 
all  who  need  it. 

School  Climes  at  Home  and  Abroad. — The  school  clinic 
which  seems  destined  to  absorb  most  of  these  health  en- 
terprises has  already  made  a  substantial  start.  It  exists, 
indeed,  in  rudimentary  form  wherever  a  school  nurse  is  em- 
powered to  administer  prescribed  treatment  for  minor  ail- 
ments or  first  aid  in  emergency  cases,  as  is  the  case  in  New 
York  and  in  a  number  of  other  American  cities.  Thus  far, 
however,  the  development  of  the  school  clinic  has  been  most 
active  in  England,  the  education  board  in  1907  having  granted 
the  power  to  local  school  boards  of  appropriating  under  their 
sanction  a  proportion  of  the  education  tax  for  the  medical 
and  dental  treatment  of  school-children. 

This  act  promptly  resulted  in  the  establishment  of  many 
school  clinics.  By  191 2  there  were  not  less  than  118  centres 
where  organizations  for  treatment  of  some  kind  or  fully 
equipped  school  clinics  were  in  operation.  Of  these,  78  had 
received  the  sanction  of  the  national  board  and  51  were  en- 
tirely provided  for  by  the  school  tax,  the  others  being  partly 
subsidized  or  wholly  philanthropic.  Defective  teeth,  as  well 
as  minor  ailments,  such  as  septic  sores,  discharging  ears,  and 
inflamed  eyes,  were  cared  for  in  practically  all  of  these  clinics. 
In  49  centres  defective  vision  was  treated;  in  48  skin  diseases; 
and  in  16  tonsils  and  adenoids.  In  5  centres  remedial  ex- 
ercises were  given  for  spinal  deformities  and  the  effects  of 
adenoids;  in  3  tuberculous  cases  were  treated,  and  in  i  help 
was  given  to  stammerers. 

Compared  with  the  treatment  provided  for  school-chil- 
dren in  any  other  country,  this  is  a  notable  showing,  but  even 
these  apparently  numerous  clinics  are  serving  only  9  per  cent 
of  the  school-children  of  Great  Britain. 

In  America  the  percentage  of  children  served  by  school 
clinics  is  far  smaller  even  than  in  England,  in  spite  of  the  fact 


25^ 


EDUCATIONAL  HYGIENE 


that  many  leading  cities  have  lately  established  dental  clinics. 
Here  and  there,  as  in  New  York  and  Philadelphia,  we  find 
an  eye  cHnic  or  one  that  treats  nose  and  throat  obstructions, 
but  there  is  no  evidence  that  there  are  as  yet  a  dozen  clinics 
in  the  country  that  give  treatment  for  anything  but  defective 
teeth.  This  situation  will  not  last,  however.  The  fair  be- 
ginning already  made  insures  a  rapid  advance.  Such  an  in- 
stitution as  the  Forsythe  Dental  Infirmary,  incorporated  in 
Boston  in  1910  with  an  endowment  of  over  $1,000,000,  will 
give  great  impetus  to  the  entire  country  in  the  direction  of 
the  pubUc  treatment  as  well  as  the  health  education  of  school- 
children. The  staff  of  the  Forsythe  Infirmary  is  composed  of 
a  number  of  consulting  dentists  who  give  their  services,  and 
a  permanent  paid  staff  of  proved  ability.  The  assistants  are 
drawn  from  authorized  dental  schools.  The  building  itself 
is  planned  for  the  most  thorough  kind  of  service;  provision 
being  made  for  one  hundred  and  eight  chairs,  and,  in  addition 
to  this,  a  waiting  room,  sterilizing  room,  research  laboratories, 
museum,  lecture  room,  extracting  and  anesthesia  rooms,  re- 
covery and  consulting  rooms. 

While  few  communities  at  present  will  probably  be  able 
to  duplicate  the  Forsythe  Dental  Infirmary,  many  can  profit 
enormously  by  the  standards  and  methods  worked  out  in 
this  highly  favored  institution. 

The  equipment  of  school  clinics  is  already  fairly  well 
standardized  and  it  is  possible  with  httle  difficulty  and  out- 
lay to  fit  up  a  moderate-sized  clinic  with  thoroughly  sanitary 
and  serviceable  arrangements.  Detailed  directions  and 
specifications  for  equipping  school  clinics,  from  the  simplest 
to  the  most  elaborate,  are  to  be  found  in  "School  Clinics  at 
Home  and  Abroad,"  by  Lewis  D.  Cruickshank,  M.D.,  and  in 
''Medical  Inspection  of  Schools,"  by  A.  H.  Hogarth,  Oxford 
University  Press.^ 

'  The  annual  reports  of  the  Chief  Medical  Officer  of  the  National  Board 
of  Education,  Whitehall,  London,  and  the  reports  of  such  cities  as  Bradford, 
Cambridge,  and  Manchester  will  be  of  great  suggestive  value.— Ed. 


PUBLIC-SCHOOL  CLINICS  253 

How  to  start  Clinics. — For  the  most  part  the  one-chair 
or  one-doctor  clinic  will  have  to  answer  the  needs  of  the 
nation's  children,  and  how  to  get  even  that  small,  simple 
clinic  started  will  be  the  pressing  problem  in  most  communi- 
ties for  the  next  few  years.  The  big  cities  may  be  trusted  to 
work  out  their  own  problems.  It  is  the  country  communities, 
where  most  American  children  still  live,  which  are  in  most 
urgent  need  of  help.  Miss  Denison,  in  her  book  on  "Help- 
ing School  Children,"  gives  an  excellent  programme  for 
developing  sentiment  in  favor  of  giving  medical  treatment  to 
school-children.  In  the  chapter  on  *'The  Dentist's  Message" 
she  calls  attention  to  the  three  centres  of  influence  that  must 
be  conquered  in  either  town  or  country  in  order  to  bring  re- 
sults. These  are  the  superintendent  of  schools,  the  leading 
dental  or  medical  society,  and  the  most  energetic  lay  organiza- 
tion.    To  quote  from  Miss  Denison: 

Through  the  first  you  have  control  of  principals,  teachers,  pupils, 
and  their  parents;  through  the  second,  of  individual  dentists,  small 
groups  and  larger,  important  county  or  State  organizations;  through 
the  third,  of  mothers'  clubs,  women's  clubs,  charity  organizations, 
public  education  associations,  and  groups  of  business  men  and  min- 
isters.    And  the  press  is  always  eager  for  good  stories. 

From  the  experience  of  many  communities  there  are  certain  good 
moves  advisable  anywhere: 

Dental  hygiene  exhibit. 

Talks  at  school  and  parents'  meetings. 

Newspaper  stories  about  dental  work  in  other  cities. 

Volunteer  committee  of  dentists  to  make  preliminary  survey  of 
one  or  more  schools. 

Publicity  of  results. 

Programme  outlined  for  dental  clinics  and  inspection. 

Support  of  lay  organizations  for  board  of  education's  requests  for 
appropriation. 

Combination  of  dental  and  lay  organizations  to  secure  a  compulsory 
law. 

When  a  community  has  reached  the  point  of  demanding  a 
school  clinic,  the  next  considerations  must  of  course  be  gov- 


254 


EDUCATIONAL  HYGIENE 


erned  by  local  conditions.  How  the  support  is  to  be  provided  , 
whether  treatment  shall  be  for  public-school  children  only  oi 
for  private  and  parochial  school  children  as  well;  whether  it 
shall  be  free  for  all  or  any  children,  or  for  a  .nominal  or  sHding 
fee — these  are  all  questions  that  must  be  worked  out  locally 
as  long  as  they  are  not  determined  by  legislation.^ 

No  matter  how  local  conditions  and  difficulties  may  vary, 
however,  it  must  be  remembered  that  the  fundamental  needs 
of  American  children  do  not  vary.  Seven  or  eight  children 
out  of  ten  in  Walla  Walla  need  dental  attention  just  as  badly 
as  they  do  in  Boston.  Obstructed  breathing  interferes  with  the 
strength  and  happiness  of  as  great  a  proportion  of  children  in 
Dakota  as  in  New  York.  Everywhere  in  this  country  the 
children  need  help  in  securing  sound  bodies.  The  school 
clinic  is  the  logical  provision  for  this  need  and  it  is  only  a 
question  of  well-directed  effort  on  the  part  of  intelligent 
leaders  when  this  institution  will  be  as  general  and  as  highly 
valued  as  the  public  school. 

SUGGESTED   EQUIPMENT   FOR  A   DENTAL   CLINIC  2 

The  rooms  selected  for  dental  work  should  have  ample  light. 
North  light  is  preferred,  as  it  is  more  uniform  and  shadows  are  less 
intense. 

The  equipment  of  a  dental  clinic  is  rather  expensive,  but  consider- 
ing its  permanent  nature,  and  the  numbers  that  are  likely  to  benefit, 
it  is  relatively  less  expensive  than  the  equipment  of  other  departments. 
It  is  scarcely  necessary  to  give  a  detailed  list  of  all  the  dressings,  etc., 
that  may  be  required.  The  following  list  of  fittings  and  instruments 
is  taken  from  the  report  of  the  School  Dentists'  Society: 

A  dental  chair. 

Cabinet. 

Bracket  table. 

Spittoon  (including  saliva  ejector). 

Five  pairs  of  dental  forceps  and  an  elevator. 

Two  dental  probes,  double-ended. 

Oiie  dental  machine  with  No.  7  handpiece  and  No.  2  right-angle 
attachment. 

•  See  also  Cabot,  "  Volunteer  Work  for  the  Schools." 

2 Prom  Cruickshank's  "School  Dental  Clinics  at  Home  and  Abroad." 


PUBLIC-SCHOOL  CLINICS  255 

One  gross  of  burs,  assorted. 

One  dozen  excavators,  N.  P.  assorted. 

Two  chisels. 

Three  scalers. 

Four  plastic  instruments. 

One  spatula. 

One  glass  slab. 

One  glass  pestle  and  mortar. 

One  college  tweezers. 

One  amalgam  spoon. 

One  mercury  holder. 

One  chip  syringe. 

One  water  syringe. 

Three  mouth  mirrors. 

One  spirit  lamp. 

One  sterilizing  tank  (gas  or  spirit). 

One  crystal  glass  sterilizing  vase. 

Gas  apparatus,  consisting  of  stand  with  upright,  bag,  tubing, 
mounts,  aseptic  3-way  stop-cock,  celluloid  face-piece,  and  two  100- 
gallon  cylinders  filled  with  nitrous-oxide  gas. 

Three  mouth  props. 

One  tongue  forceps. 

One  mouth  opener. 

One  sponge  holder. 


CHAPTER  XV 
OPEN-AIR  AND   OPEN-WINDOW   SCHOOLS 

The  Problem. — The  open-air  school  movement  has  gained 
a  definite  place  among  the  educational  and  ameliorating 
forces  of  the  United  States.  Its  development  has  been  rapid, 
for  it  is  based  upon  the  experiences  and  knowledge  acquired 
by  an  increasing  number  of  social  workers  and  social  agencies 
over  a  considerable  number  of  years.  Settlement  workers, 
agents  for  charitable  organizations,  tuberculosis  agents,  visit- 
ing nurses,  juvenile  court  workers,  infant  welfare  nurses, 
probation  officers,  church  visitors,  teachers  and  members  of 
school  boards,  and  a  growing  number  of  interested  citizens 
have  made  the  acquaintance  of  thousands  of  children  living 
under  our  rapidly  changing  modern  conditions. 

In  increasing  numbers  these  representatives  have  gone 
into  the  homes  where  poverty,  sickness,  delinquency,  defect- 
iveness, and  all  manner  of  unfortunate  circumstances  have 
called  them  on  their  errands  of  neighborliness.  They  have 
come  close  to  the  homes  of  the  poor  and  have  acquired  a 
first-hand  knowledge  of  the  handicaps  under  which  less  for- 
tunate people  live.  The  bearing  which  untoward  circum- 
stances have  upon  the  lives  of  children  has  impressed  itself 
upon  these  workers  as  of  paramount  importance  to  the  com- 
munity and  the  nation.  The  earlier  efforts  were  for  measures 
of  relief.  They  endeavored  to  secure  braces  for  crooked  legs 
and  crooked  backs,  to  get  hospital  care  for  children  who  were 
ill,  to  acquire  an  understanding  which  would  help  them  to  get 
boys  and  girls  out  of  trouble,  or  to  secure  them  employment; 
or  they  went  from  the  compulsory  education  department  to 
force  children  into  school;  or  from  the  courts  to  secure  infor- 

256 


OPEN-AIR   AND    OPEN- WINDOW    SCHOOLS  257 

mation  about  dependency  and  delinquency.  These  workers 
found  large  numbers  of  children  anemic,  undersized,  and  ill 
prepared  physically  and  mentally  for  the  duties  of  life.  They 
learned  that  thousands  of  them  had  dropped  out  of  school  at 
an  early  age  and  that  the  school  experience  had  effected  little 
or  no  beneficial  result. 

A  procession  of  something  like  100,000  children  a  year 
files  before  the  courts  of  the  country,  and  the  stories  that 
have  been  confided  to  the  ear  of  the  friendly  judge  by  troubled 
children  and  heart-broken  parents  have  been  challenging  the 
attention  of  the  nation.  In  following  the  trail  of  these  little 
people  into  their  homes,  probation  officers  have  become  pos- 
sessed of  information  and  understanding  which  throws  a 
great  deal  of  light  on  the  reasons  why  children  drop  out  of 
school,  as  well  as  why  they  fail  in  their  studies  and  cannot 
keep  up  with  the  procession,  why  they  get  into  trouble  and 
do  not  fit  into  the  industrial  life  of  the  community.  From 
purely  palliative  and  remedial  work  a  widening  number  of 
interested  people  have  been  challenging  the  situation  and  de- 
manding a  constructive  programme.  What  the  problem  is  for 
one  disease  the  following  figures  suggest. 

Influence  of  Medical  Inspection. — Medical  inspection  in 
the  public  schools  has  had  a  great  bearing  on  the  problem. 
In  191 1  over  five  hundred  cities  in  the  United  States  had  a 
system  of  medical  examination  of  school-children.  Between 
one-half  and  two-thirds  of  the  children  examined  were  found 
to  have  one  or  more  physical  defects  sufficiently  pronounced 
to  need  attention,  many  of  them  so  serious  as  to  handicap  the 
child  in  his  school  work,  and  still  others  so  marked  as  to  make 
his  attendance  at  school  dangerous  to  himself  and  to  others. 

Discovering  defects  was  the  first  step,  but  only  the  first. 
So  far,  less  than  one-half  of  the  defects  discovered  have 
been  corrected.  This  work  is  becoming  more  efficient  as 
school  nursing  is  provided,  but  there  is  still  need  for  increasing 
the  faciUties  for  hospital,  dispensary,  and  dental  care,  for 
eye  defects,  and  for  operations  for  adenoids  and  tonsils. 


2  58  EDUCATIONAL   HYGIENE 

In  a  recent  book,  "The  Prevention  of  Destitution,"  Sid- 
ney Webb  writes  as  follows  of  medical  inspection  and  its  re- 
sults in  England: 

When  we  get  the  child  to  school,  knowledge  of  its  condition  becomes 
forced  upon  the  community.  The  first  results  of  systematic  medical 
inspection  are  bringing  home  to  our  minds  what  every  teacher  knows, 
namely,  that  a  large  proportion  of  the  children  are  not  in  a  fit  state 
to  have  the  public  money  spent  on  teaching  them,  because  they  are 
suffering  to  such  an  extent  from  neglect  as  to  be  unable  to  obtain  full 
advantage  of  the  instruction.  What  emerges  from  the  cautious  sum- 
maries of  the  chief  medical  officer  of  the  Board  of  Education  for 
England  and  Wales  (Scotland  and  Ireland  being  at  least  as  bad)  is 
that  out  of  all  the  6,000,000  children  in  the  elementary  schools  about 
10  per  cent  suffer  from  serious  defects  in  vision;  from  3  to  5  per  cent 
suffer  from  defective  hearing;  i  to  3  per  cent  from  suppurating  ears; 
8  per  cent  have  adenoids  or  enlarged  tonsils  of  sufficient  degree  to 
obstruct  the  nose  or  throat  and  to  require  surgical  treatment;  20  to 
40  per  cent  suffer  from  e.xtensive  and  injurious  decay  of  the  teeth;  40 
per  cent  have  unclean  heads;  about  i  per  cent  suffer  from  ringworm; 
I  per  cent  are  affected  with  tuberculosis  of  readily  recognizable  form; 
and  >^  to  2  per  cent  are  afflicted  with  heart-disease. 

Infant  Welfare  Organizations. — One  of  the  newer  and  most 
fundamental  movements  has  gone  straight  to  the  heart  of 
the  problem  of  physical  welfare  of  children,  and  that  is 
the  work  of  the  infant  welfare  organizations.  These  people 
have  found  that  we  have  about  250,000  baby  funerals  in  this 
country  annually  of  children  in  their  first  year.  This  means 
about  150  out  of  every  1,000  babies.  This  is  better  than  the 
figure  in  Russia,  where  it  is  263,  but  it  is  a  sad  comparison 
with  New  Zealand,  where  it  is  less  than  75.  These  were  our 
figures  as  given  by  the  American  Association  for  the  Preven- 
tion and  Study  of  Infant  Mortality  in  1911. 

It  has  been  stated  that  the  mortality  among  infants  is  one 
of  the  best  indexes  of  the  community's  concern  for  human 
life.  The  story  of  such  mortahty  as  this  is  not  fully  told  in 
the  frequent  use  of  the  white  hearse,  for  many  children  sur- 
vive only  to  emerge  from  the  dangers  of  babyland  with  im- 


Open-air  classrocm,  exterior,  Hackensack,  X.  J. 


Open-air  ckissroom,  interior,  Hackensack,  X.  J. 
Note  equipment.     Cots  in  the  foreground 


OPEN-AIR  AND   OPEN-WINDOW   SCHOOLS 


259 


paired  physique  and  weakened  resistance.  All  children  must 
be  babies  first,  and  the  candidates  for  the  schools  must  pass 
through  the  ignorance  and  dangers  of  babyland;  and  these 
figures  show  that  being  a  baby  is  about  the  most  hazardous 
pursuit  in  the  world. 

TABLE 1 

Death-Rate  from  Tuberculosis 


AGE  PERIOD 

DEATH-RATE    FROM    TUBERCULOSIS    (ALL    FORMS) 
PER    100,000    POPULATION   OF   THE   STATES   IN- 
CLUDED IN  THE  REGISTRATION  AREA   IN  IQOO." 

(94,20s  deaths) 

PER    CENT     WHICH 
RATE      IN      I91I 
REPRESENTS      OF 

I9II 

1901 

THAT  IN  1901 

Both 
sexes 

Males 

Fe- 
males 

Both 
sexes 

Males 

Fe- 
males 

Both 
sexes 

Males 

Fe- 
males 

All  ages: 

Crude  rate 

Corrected  rate' . . . 

Under  5  years 

f  5  to  g  years 

<  10  to  14  years. . . . 

(  IS  to  19  years 

20  to  24  years 

25  to  34  years 

35  to  44  years 

45  to  54  years 

55  to  64  years 

65  to  74  years 

75  years  and  over.. . 

25  years  and  over: 

Crude  rate 

Corrected  rate'. . . 

158.9 
150. 1 

179-4 
167.0 

138.0 

134-4 

188.8 
181. 3 

199.9 
189.3 

177.6 
173.8 

84 
83 

90 
88 

78 
77 

126.7 

35-6 
iiS-3 
188.0 
217.8 
228.4 
191. 0 
193.6 
IQ4-3 
158-6 

209.3 

206.5 

133-3 
31-4 
27.6 
99.9 
190.9 
230.4 
278.5 
253-S 
253-0 
229.9 
177. 1 

249.1 
248.8 

120.0 
30.9 
43-7 
130.4 
185.2 
204.6 
175-5 
124.6 
133-4 
i6o.6 

143 -I 

168. 1 
168.6 

138.2 
310 
39-4 

144.2 

251-9 
282.6 
254-7 
208.8 
220.2 

253-5 
241 .0 

251.0 
249-1 

147-7 
31-6 
26.5 
118. 1 
247-3 
287.0 
285.9 
256-5 
267.3 
284.3 
256-3 

277-7 
277.6 

128.6 
30.4 
52.4 
169. 1 
256.2 
278.2 
221.6 
159.0 
173-9 
224.3 
227-5 

223.7 
223.6 

92 
100 
90 
80 
75 
77 
90 
91 
88 
77 
66 

83 
83 

90 
99 

104 
85 
77 
80 
97 
99 
95 
81 
69 

go 
90 

93 

102 

83 

77 

72 
74 
79 
78 
77 
72 
63 

75 

75 

iFrom  igii  U.  S.  Mortality  Statistics. 

2  Includes  Connecticut,  the  District  of  Columbia,  Indiana,  Maine,  Massachusetts, 
Michigan,  New  Hampshire,  New  Jersey,  New  York,  Rhode  Island,  and  Vermont.  Regis- 
tration area  included  63.1  per  cent  of  the  population. 

'  Corrected  on  basis  of  standard  million  of  England  and  Wales,  igoi. 

Note. — ^The  column  for  "both  sexes"  third  from  the  right  side  means,  for  example, 
that  the  crude  rate  from  tuberculosis  for  all  ages  was  only  84  per  cent  of  what  it  was  in 
1901,  and  that  the  rate  for  children  from  5  to  9  years  was  unchanged. 


Our  schools,  then,  are  constantly  recruited  by  an  army 
of  little  people  of  weakened  resistance,  ill  nourished,  im- 
properly cared  for,  and  poor  material  to  be  wrought  upon  by 
the  school  regime.    The  school  process  has  gone  on  without 


26o  EDUCATIONAL  HYGIENE 

that  consciousness  of  individual  needs,  that  discriminating 
concern  for  each  child,  to  which  it  would  seem  that  the  most 
handicapped,  at  least,  are  entitled.  The  general  tuberculosis 
crusade  with  its  carefully  worked  out  programmes  has  been 
one  of  the  most  pronounced  factors  in  setting  the  community 
at  work. 

The  open-air  school  is  one  of  the  pieces  of  social  ma- 
chinery that  have  come  into  existence  because  of  these  ex- 
periences and  the  convictions  which  have  grown  out  of  them. 

Open-Air  Schools  at  Home  and  Abroad. — The  open-air 
school,  in  the  modern  acceptance  of  the  term,  was  started  in 
Charlottenburg  in  1904  as  a  rest-recovery  school.  It  was  a 
fresh-air  camp  for  debilitated  children,  located  in  a  beauti- 
ful pine  forest  just  outside  Charlottenburg,  a  suburb  of  Berlin. 

The  German  people  were  first  in  the  field  in  sanatorium 
treatment  for  tuberculosis.  They  soon  discovered  that  if  de- 
bilitated children  were  sent  to  the  sanatorium,  while  they 
gained  in  health  they  lost  in  educational  progress.  On  the 
other  hand,  if  they  were  kept  in  the  public  schools  they  de- 
teriorated in  health. 

The  now  famous  Waldschule  provided  the  missing  link 
and  became  a  real  educational  experiment,  but  with  the 
teaching  always  secondary  to  health.  New  methods  of  in- 
struction were  devised,  and  a  rich  and  varied  programme  was 
worked  out  for  the  children.  Their  school  day  included,  be- 
sides the  ordinary  recitations,  gardening,  walks  in  the  forest, 
nature-study  work,  five  feedings  a  day,  sun-bath,  gymnastics 
in  the  open  air,  and  a  rest  period  from  one  to  two  hours  in 
length. 

In  his  report  for  191 2  the  chief  medical  officer  of  the  Board 
of  Education  in  London  makes  the  following  statement: 

Open-air  education  was  practised  by  the  Greeks  and  Romans,  was 
commended  by  the  educationalists  of  the  seventeenth  and  eighteenth 
centuries— Locke,  Rousseau,  and  Pestalozzi— and  has  been  attempted 
in  various  forms  since  1876,  when  Bion,  of  Zurich,  initiated  the  chil- 
dren's country-holiday  movement.     The  growing  of  the  towns,  the  in- 


OPEN-AIR  AND   OPEN- WINDOW   SCHOOLS  26 1 

crease  of  social  effort  and  experiment,  and  the  movement  for  the  pre- 
vention and  treatment  of  tuberculosis  have,  no  doubt,  been  factors 
in  the  recent  progress  of  the  open-air  school  movement.  In  1907  the 
London  County  Council  established  a  school  of  this  kind  at  Bostall 
Wood,  and  there  are  now  about  a  dozen  schools  in  different  parts  of 
the  country. 

France,  Switzerland,  Italy,  and  Hungary  have  open-air 
schools  with  similar  curricula  and  management.  In  general, 
the  tendency  in  Europe  is  to  construct  open-air  schools  in 
the  country  on  a  plan  which  permits  giving  the  children  day 
and  night  care  until  their  recovery  is  assured. 

The  first  open-air  school  in  the  United  States  was  estab- 
lished in  1908  at  Pro\ddence,  Rhode  Island.  There  are  at 
the  time  of  writing  more  than  500  open-air  schools  and  open- 
window  classes  in  the  United  States.  Passing  through  the 
makeshift  period,  when  ferry-boats,  piazzas,  and  tents  were 
used  for  schoolrooms,  the  open-air  school  movement  has  pro- 
gressed to  the  stage  where  school  architects  are  incorporating 
specially  designed  rooms  for  such  work  in  the  plans  of  their 
most  recent  buildings. 

Principles  and  Methods  of  Open-Air  Schools. — The 
method  and  aim  of  the  open-air  school  is  to  furnish  the  child 
with  a  programme  suited  to  his  needs.  It  is  not  merely  school 
in  the  open  air;  it  comprises  a  way  of  life  and  a  system  both 
of  education  and  medical  treatment.  The  children  are  ad- 
mitted to  such  schools  through  a  careful  medical  examina- 
tion, the  aim  of  which  is  to  secure  accurate  knowledge  of  the 
child's  physical  condition.  This  information  furnishes  the 
guide  for  such  medical  treatment  and  correction  of  physical 
defects  as  are  necessary  to  establish  the  efficiency  of  the  pupil. 
A  daily  inspection  by  the  physician  in  charge  gives  opportu- 
nity to  check  any  temporary  indisposition  and  to  study  the 
effect  of  the  modified  regime  upon  the  individual  child. 

In  most  open-air  schools  temperature  and  pulse  are  re- 
corded at  least  once  daily  and  the  children  are  weighed  at 
stated  intervals.     A  daily  cold  shower-bath  or  a  weekly  warm 


262  EDUCATIONAL  HYGIENE 

cleansing  bath  is  ordinarily  given  at  the  school.  Meals  are 
served  from  once  to  three  times  during  the  day.  The  physi- 
cian plans  the  diet  list  and  often  orders  special  diets  for  badly 
undernourished  children. 

A  rest  period  usually  follows  the  noon  meal.  All  the 
children  recline  on  canvas  cots  or  steamer-chairs  for  a  period 
varying  from  forty-five  minutes  to  two  hours.  Ordinarily, 
two-thirds  sleep  regularly;  at  any  rate,  they  rest.  Where  a 
child  does  not  waken  at  the  end  of  the  period  and  has  seemed 
to  be  in  special  need  of  rest,  the  teacher  may  permit  him  to 
remain  asleep  until  the  close  of  the  school  day. 

The  nursing  supervision  extends  from  the  school  into  the 
home.  The  majority  of  open-air  schools  in  this  country  are 
in  the  congested  portions  of  cities,  where  the  daily  lives  and 
habits  of  children  are  not  so  well  or  so  carefully  regulated  as 
they  would  be  in  smaller  communities.  The  children  go  to 
bed  late  and  usually  sleep  with  other  persons  in  poorly  ven- 
tilated rooms. 

The  19 1 2  report  of  the  London  Board  of  Education  points 
out  "that  it  would  be  difficult  to  exaggerate  the  physical 
and  mental  injury  its  children  suffer  from  a  lack  of  sufficient 
sleep  and  genuine  rest.  Large  numbers  of  children  who  re- 
quire for  physical  health  at  least  ten  hours'  rest  at  night  are, 
in  fact,  obtaining  much  less  than  that  amount;  and  this  one 
condition  is  responsible  for  not  a  little  of  their  physical  un- 
fitness and  mental  dulness.  Further,  there  are  various  mal- 
adies from  which  they  suffer  and  which  are  being  revealed  by 
medical  inspection,  which  call  for  the  therapeutic  remedy  of 
rest." 

The  teacher  in  a  Boston  open-air  school  says  that  the  open- 
air  school  must,  in  an  unusual  sense,  be  mother  and  school 
both.  "It  is  found,"  she  says,  "that  many  of  our  pupils  are 
up  until  all  hours  of  the  night  and  out  again  early  in  the  morn- 
ing. They  are  improperly  clothed,  improperly  fed,  never 
bathed,  and  live  in  rooms  that  are  never  ventilated  and  are 
occupied  by  three,  four,  and  five  others.     Often  they  come  to 


OPEN-AIR  AND   OPEN- WINDOW   SCHOOLS  263 

school  unfed,  not  always  because  there  is  no  food,  but  because 
there  is  no  regular  living  and  food  has  not  happened  to  come 
their  way.  If  it  does,  it  is  more  than  probably  not  the  right 
kind.  It  may  have  been  soggy,  half-baked  bread  with  a  little 
pepper  on  it  to  'keep  them  warm.'  " 

The  nurse  who  cares  for  the  children  at  the  school  goes 
with  them  to  their  homes  and  tries  to  enlist  the  co-operation 
of  the  parents  in  giving  the  child  better  food,  better  ven- 
tilation, and  better  sleeping-quarters.  In  the  Chicago  open- 
air  schools  it  was  found  necessary  to  make  a  ruling  that  any 
child  who  persisted  in  remaining  up  after  eight  o'clock  at  night, 
without  good  reason,  should  be  excluded  from  the  school. 

The  influence  of  the  nurse  has  often  accomplished  the 
removal  of  a  whole  family  from  insanitary  quarters  where 
privacy  and  decency  were  well-nigh  impossible  to  homes 
which  corresponded  more  nearly  with  hygienic  standards. 
The  nurse  accompanies  the  children  to  the  dispensaries,  in- 
vestigates at  once  in  case  of  absence  from  the  open-air  school, 
and,  in  general,  watches  over  the  physical  well-being  not  only 
of  the  pupil  himself  but  of  his  family. 

Structure  and  Equipment. — The  distinctly  open-air  school 
is  one  where  the  air  is  practically  the  equivalent  of  outdoor 
air.  Windows  and  wind-breaks  are  so  placed  as  to  control 
the  entrance  of  storm  and  wind. 

The  first  open-air  schools  in  the  United  States  utilized 
existing  buildings  by  modifying  the  window  structure,  or 
erected  cheap  temporary  shacks  to  serve  as  their  experiment 
stations.  Thus  Providence  estabhshed  the  first  school  in  an 
abandoned  schoolhouse,  Boston  on  the  roof  of  a  park  re- 
fectory, Pittsburg  on  a  hospital  balcony.  New  York  on  dis- 
used ferry-boats,  while  Chicago  built  asbestos  shacks  on  the 
roofs  of  convenient  buildings  in  the  tenement  districts. 

Climate  and  local  conditions  determine  absolutely  the  type 
of  building  best  suited  for  open-air  work  in  any  particular 
community.  The  rapid  increase  in  the  number  of  open-air 
schools  has  led  several  cities  to  make  permanent  provision  in 


264  EDUCATIONAL  HYGIENE 

their  regular  school  system  for  open-air  work.  Boston,  New 
York,  and  Oakland,  California,  are  among  the  cities  which 
have  definitely  decided  to  incorporate  fresh-air  rooms  in  all 
new  buildings  to  be  erected. 

This  new  development  in  schoolhouse  architecture  is 
more  marked  as  yet  in  those  Western  States  whose  climates 
permit  of  open  windows  and  no  heat  during  a  good  part  of 
the  school  year. 

In  California  practically  all  the  new  buildings  are  being 
erected  in  such  a  way  that  they  can  be  thrown  entirely  open 
on  at  least  one  side.  In  the  Eastern  cities,  where  ground  is  at 
a  premium  and  transportation  is  poor,  more  roofs  have  been 
pressed  into  service.  Cleveland  has  a  magnificent  new  build- 
ing, the  roof  of  which  was  specially  planned  to  accommodate 
four  open-air  schools.  The  children  are  taken  to  the  roof  by 
an  electric  elevator,  and  play-space,  recitation-rooms,  rest- 
rooms,  kitchen,  and  dining-room  are  all  provided  on  the  roof. 
Detroit  will  erect  two  such  buildings  within  a  year.  Many 
cities  are  modifying  the  style  of  windows  in  their  school- 
houses,  substituting  for  the  old-style  windows  hinged  windows, 
to  swing  either  in  or  up  and  to  occupy  a  larger  portion  of  the 
wall  space. 

Another  recent  suggestion  is  that  of  substituting  open 
verandas  for  the  long,  dark  hallways  of  the  ordinary  school- 
house.  The  architect  claims  that  such  a  building  would  be 
much  less  expensive  to  construct  and  far  safer  in  case  of  fire. 
It  would  permit  of  long  windows  opening  on  the  verandas, 
which  could  be  thrown  open  in  case  of  favorable  weather. 

Portable  buildings  are  used  in  the  yards  of  schoolhouses 
in  many  places.  In  Europe  the  Doecker  portables  are  used 
very  largely  for  open-air  work  and  were  awarded  a  gold  medal 
at  the  Third  International  Congress  on  School  Hygiene. 

The  open-window  room  is  a  room  in  the  ordinary  school 
building  in  which  an  attempt  is  made  to  approximate  outside 
conditions  by  regulating  the  amount  of  heat  supplied  and  by 
keeping  the  windows  constantly  open.      Here,   also,   wind- 


OPEN-AIR   AND   OPEN- WINDOW   SCHOOLS  265 

shields  of  various  devices  are  used  to  keep  the  air  from  blow- 
ing directly  on  the  children.  The  temperature  in  cold  weather 
averages  about  fifty-five  degrees  in  such  rooms.  The  contrast 
between  the  freshness  and  purity  of  the  air  in  the  open  rooms 
and  that  in  other  rooms  of  the  same  building  with  artificial 
ventilation  in  use  is  extremely  marked.  The  difference  in 
temperature  is  made  up  by  extra  feeding  and  by  extra  clothes. 
There  is  always  the  need  of  careful  medical  supervision,  and 
it  would  be  a  hardship  to  the  children  to  subject  them  to  the 
lower  temperature  without  adequate  provision  for  clothing. 

In  the  schools  of  Chicago  children  are  furnished  with 
lumbermen's  boots  or  other  foot-protection,  and  with  sweaters 
or  Eskimo  suits  for  schoolroom  use.  There  is  always  need 
that  either  the  physician  or  teacher,  especially  the  latter, 
shall  see  to  it  that  the  children  put  on  wraps  when  the  tem- 
perature is  low,  as  they  will  often  themselves  declare  they  are 
warm  enough  and  fail  to  put  on  the  additional  garments. 

The  individual  equipment  for  a  child  in  an  open-air 
school  includes  boots,  Eskimo  suit  or  other  warm,  loose  gar- 
ments with  gloves  or  mittens,  sleeping-bag,  blankets,  cot, 
tooth-brush,  paper  napkins,  and  thermometer. 

The  school  equipment  must  include,  in  addition  to  desks, 
blackboards,  and  the  ordinary  furnishings  of  the  schoolroom, 
provision  for  serving  meals  and  some  kind  of  locker  in  which  the 
suits  and  other  articles  of  individual  equipment  may  be  kept. 

Results  of  Treatment. — So  uniform  has  been  the  record 
of  the  mental  and  physical  improvement  of  the  children  under 
the  open-air  regime  that  detailed  statements  of  gains  seem 
hardly  necessary.  We  expect  increases  in  weight,  height, 
chest-expansion,  and  muscular  power,  improved  nutrition, 
better  color,  and  more  erect  carriage;  and  we  know  that  with 
these  physical  gains  will  come  greater  alertness  and  more 
power  of  concentration,  consequently  better  scholarship  and 
more  regular  attendance. 

It  is  of  special  interest,  however,  to  compare  these  records 
with  those  of  children  in  the  public  schools.    Such  a  comparison 


266  EDUCATIONAL  HYGIENE 

was  made  during  the  school  year  191 2-13  by  Doctor  Harold 
Brown  Keyes  between  the  children  in  the  outdoor  classes  of 
the  Horace  Mann  School,  Columbia  University,  and  cor- 
responding grades  indoors  in  the  same  school.  These  are  all 
supposedly  normal  children  from  good  homes. 

The  hemoglobin  tests  given  at  a  six  months'  interval 
showed  that,  although  both  indoor  and  outdoor  children  lost 
in  hemoglobin,  the  outdoor  children  lost  only  about  one-ninth 
as  much  as  the  indoor.  A  comparison  between  the  past  at- 
tendance-records of  fourteen  fourth-grade  children  in  the  open- 
air  school  and  indoors  gave  a  better  record  of  4.3  per  cent  in 
favor  of  the  outdoor  schools.  The  children  were  two  years 
older,  however,  than  when  the  first  record  was  made. 

A  record  of  contagious  diseases  kept  during  the  year 
showed  that  12.5  per  cent  of  the  outdoor  children  had  con- 
tagious disease  to  17.9  per  cent  of  indoor  children.  No  con- 
tagious disease  "went  through"  an  outdoor  room,  as  happened 
in  one  of  the  indoor  rooms.  There  was  far  less  absence  for 
illness. 

In  the  mental  tests,  to  quote  only  two  examples,  the  third- 
grade  open-air  school  children  tested  in  formal  English  showed 
a  20  per  cent  improvement  from  December  to  May,  while  the 
indoor  gained  13  per  cent;  the  outdoor  fourth  grade  gained  7 
per  cent  and  the  indoor  fourth  grade  lost  3  per  cent.  In  arith- 
metic, the  third-grade  open-air  improved  20  per  cent  and  the 
indoor  6  per  cent,  while  the  fourth  grade  made  41  per  cent  in 
the  open  air  and  35  per  cent  indoors. 

The  supervising  physician  of  the  Bradford,  England,  open- 
air  school  reports  that  the  results  for  191 2  showed  remarkable 
gains  in  weight  and  health  and  increase  of  the  percentage  of 
hemoglobin  in  the  blood.  The  average  attendance  for  the 
year  was  138.3  and  the  average  duration  of  attendance  rather 
more  than  five  months.  The  average  gain  in  weight  was 
about  four  and  one-half  pounds.  There  was  an  increase  of 
21.5  hemoglobin,  and  the  chest-measurements  showed  an 
average  increase  of  1.12  inches. 


Weight  recorded  each  Monday  and  Friday.     Friday  gain  and  Monday 
loss  noted.     Dyer  Open  Air  School,  Cincinnati,  O. 


OPEN-AIR  AND   OPEN- WINDOW   SCHOOLS  267 

The  school  medical  officer  at  Halifax,  England,  draws 
certain  general  conclusions  from  his  additional  experience  in 
the  treatment  of  debilitated  children.     He  states: 

(i)  Cases  of  malnutrition  with  its  attendant  anemia,  debility,  etc., 
give  uniformly  good  results  under  open-air  school  treatment,  unless 
counteracted  by  home  influences  at  night  and  week-ends. 

(2)  Simple  tubercular  glands  are  quickly  influenced.  In  the 
three  cases  reported  "fair"  or  "worse,"  there  were  lung  signs  suffi- 
cient to  account  for  the  poor  progress. 

(3)  Heart  cases  if  compensated,  and  enfeebled  circulation,  respond 
well. 

(4)  Early  manifest  phthisis  responds  better  than  the  latent  or 
suspected  type  characterized  above  as  pretubercular.  This  confirms 
our  previous  experience  that  a  child  saturated  with  tuberculous  poison, 
without  manifest  signs,  is  a  more  difficult  problem  than  the  child  with 
an  open  lesion. 

Should  the  children  themselves  be  asked  how  the  open-air 
school  has  affected  them,  they  would  almost  without  exception 
give  unconscious  testimony  to  the  change  which  has  been 
wrought  in  their  mental  attitude  as  well  as  in  their  physical 
condition. 

A  little  Italian  boy  in  Boston,  writing  to  his  teacher  in 
an  Enghsh  exercise,  says:  "I  come  to  school  to  learn.  When 
I  went  through  the  rooms  I  am  going  to  college,  and  after  I 
went  to  college  I  am  going  to  work  in  an  office,  and  I  thank 
you,  Miss  Dally,  for  making  me  smart,  and  I  thank  you  for 
the  malted  milk,  and  I  thank  you  for  bringing  me  into  the 
yard." 

An  Open-Air  Letter. — Another  child  in  a  Chicago  open-air 
school  wrote  the  following  autobiography  for  The  Open  Air 
Smile,  a  little  paper  which  is  published  monthly  by  the  chil- 
dren attending  the  Elizabeth  McCormick  open-air  schools: 

I  was  born  in  Russia,  May  25,  1899.  I  can  speak  the  Russian 
language  and  my  nationality  is  Jewish.  I  was  born  in  a  little  gray 
house  in  a  little  country  town  near  the  city  of  Kiev. 

When  I  was  two  years  old  my  downfall  began.     First  I  fell  sick 


268  EDUCATIONAL  HYGIENE 

and  had  the  scarlet  fever,  and  as  soon  as  I  was  cured  of  that  I  caught 
diphtheria,  and  after  I  was  cured  of  that  I  caught  pneumonia.  I 
stayed  in  bed  for  a  year  and  I  never  got  out  of  bed  for  that  long  time. 
I  believe  that  all  of  these  sicknesses  left  me  tubercular. 

When  I  was  six  years  old  I  came  to  America  and  to  the  city  of 
Chicago.  Everybody  had  told  us  in  Russia  that  gold  was  lying  every- 
where in  the  streets.  I  started  to  go  to  school  at  the  Garfield  school. 
Later  we  moved  to  a  different  street,  so  I  took  a  transfer  to  the  Lang- 
land  school,  and  later  on  we  moved  again,  and  then  I  came  to  the 
Goodrich  school,  which  I  attended  a  couple  of  years.  When  I  was 
finally  in  the  seventh  grade  I  was  sent  out  to  the  Winfield  Tuberculosis 
camp.  I  stayed  there  six  months  because  I  was  charged  with  having 
tuberculosis.  Those  six  months  passed  away  so  quickly  that  it  seemed 
to  me  like  six  weeks.  I  think  it  was  the  happiest  time  of  my  life  stay- 
ing out  there. 

Everybody  was  very  kind  and  nice  to  me  out  there.  They  were 
very  sorry  when  I  went  home,  but  when  I  finally  came  back  from 
Winfield  I  was  a  changed  fellow.  Hardly  anybody  recognized  me, 
because  I  was  not  the  sick  little  fellow  that  I  was  when  I  went  to  Win- 
field, but  a  big,  strong  and  healthy  boy  with  cheeks  like  roses.  Latei 
on  I  was  put  in  the  Foster  Open  Window  Room,  where  I  am  now  in 
the  eighth  grade. 

Other  items  which  show  the  results  of  the  open-air  school 
upon  the  child's  attitude  follow: 

When  I  was  on  the  street  car  and  was  going  to  open  the  window 
the  conductor  said  that  I  should  keep  the  window  closed.  I  told  him 
that  I  was  not  used  to  closed  windows.  There  was  a  lady  sitting  right 
next  to  me  and  she  said  that  I  was  right.  I  did  not  open  the  window, 
but  I  went  out  where  the  motorman  stands.  I  told  him  that  and  he 
laughed  about  the  conductor.  I  asked  him  to  open  the  window  and 
he  opened  it.  When  I  got  home  I  told  my  mother  and  she  said  I  was 
right. 

We  almost  lost  two  of  our  classmates  this  month.  Harry  Row's 
and  Olga  Zemit's  fathers  moved  out  of  the  district.  All  their  brothers 
and  sisters  got  transfers  and  are  going  to  another  school,  but  Olga 
and  Harry  take  the  car  and  come  to  our  school  every  day.  They  said 
their  mothers  did  not  want  them  to  leave  our  room  because  they  were 
so  much  better  than  they  used  to  be,  and  they  were  afraid  they  would 
not  keep  so  well  if  they  left  us, 


OPEN-AIR  AND   OPEN- WINDOW   SCHOOLS  269 

When  I  told  my  mother  that  we  did  not  have  any  school  for  a 
whole  week,  she  said,  "I  bet  you  will  be  two  pounds  less."  When  I 
got  back  to  school  and  was  weighed  I  was  two  pounds  and  a  quarter 
less,  so  my  mother  was  right. 

Effect  on  Teachers. — The  reflex  action  of  the  outdoor  life 
on  the  teacher  can  best  be  stated  by  those  who  have  experi- 
enced it.  "Those  who  have  tried  the  outdoor  work  have 
been  capable  of  more  prolonged  labor  with  far  less  fatigue," 
says  the  teacher  of  the  first  Boston  open-air  school.  "The 
work  is  heavier  in  an  open-air  class  but  I  feel  much  more 
able  to  accomplish  it.  After  the  day's  work  I  now  return 
home  fresh  and  do  not  suffer  from  the  usual  headache  and 
dryness  of  throat  that  follow  teaching  in  the  ordinary  room," 
comes  from  New  York;  while  an  Elizabeth  McCormick  open- 
air-school  teacher  testifies  that  backache,  extreme  fatigue, 
and  nervousness  have  been  overcome  by  the  fresh  air  and 
sunshine  on  the  roof. 

A  district  supervisor  of  the  Chicago  public  schools  reports 
to  the  board  of  education  in  regard  to  the  open-air  school 
teachers  who  are  under  her  direct  supervision  as  follows: 

When  a  teacher  has  twenty-five  pupils  who  represent  anywhere 
from  two  to  seven  different  grades;  when  her  recitations  are  inter- 
rupted by  the  call  of  a  physician  or  nurse;  when  entire  classes  are  put 
to  rest  for  the  day  at  the  menacing  demand  of  a  "rise  in  temperature," 
she  is  obliged  to  meet  the  situation  with  cleverness  and  calm.  How  is 
she  enabled  to  do  this  ?  Not  alone  because  she  is  breathing  the  purest 
air  this  smoky  city  can  bestow,  but  because  her  small  number  of 
pupils,  her  comprehensive  knowledge  of  their  physical,  mental,  and 
home  conditions,  her  interest  in  their  all-around  development,  have 
brought  her  into  a  close  human  relationship  with  them  not  often 
attainable  under  the  conditions  of  the  ordinary  schoolroom.  She  is 
their  intimate  friend  as  well  as  their  teacher. 

The  teachers  pass  on  the  enthusiasm  for  fresh  air  to  their 
fellow  workers,  and  gradually  the  impression  permeates  the 
teaching  force  that  it  is  better  to  have  the  windows  open  and 
the  room  temperature  lower.    Engineers  and  janitors  fall  into 


270 


EDUCATIONAL  HYGIENE 


line,  and  presently  the  parents  discover  that  school  ventila- 
tion is  a  very  live  issue. 

In  December,  19 13,  the  superintendent  of  schools  in 
Middletown,  Conn.,  issued  what  is  supposed  to  be  the  first 
sweeping  order  to  turn  practically  every  school  in  the  town 
into  an  open-window  school.  The  parents  were  notified  that 
beginning  on  a  certain  date  the  temperature  in  all  school- 
rooms would  be  lowered  and  the  windows  kept  open;  that 
care  would  be  taken  to  keep  draughts  from  blowing  directly 
upon  the  children  and  any  child  who  brought  a  written  ex- 
cuse from  the  family  physician  would  be  placed  in  a  heated 
room.  Parents  unable  to  provide  extra  clothing  for  their 
children  were  to  be  helped  by  the  board  of  education. 

The  influence  which  the  open-air  schools  are  exerting 
upon  schoolhouse  architecture  has  been  indicated  under  the 
section  on  '^  Construction  and  Equipment." 

With  our  increased  knowledge  of  tuberculosis  and  the 
best  means  of  avoiding  it,  and  our  realization  of  the  large 
number  of  physically  subnormal  children  in  addition  to  those 
definitely  tuberculous  who  would  be  benefited  by  the  open- 
air  school  regime,  the  open-air  school  question  is  assuming 
large  proportions. 

The  Pennsylvania  school  code  already  excludes  from  the 
public  schools  any  person  having  tuberculosis  of  the  lungs, 
whether  it  be  teacher,  pupil,  janitor,  or  other  employee. 
The  result  in  Pennsylvania  has  been  to  stimulate  the  establish- 
ment of  a  large  number  of  open-air  schools  which  have  been 
uniformly  successful  in  caring  for  the  excluded  children. 

In  England  the  tuberculosis  regulations  of  191 2  make 
the  notification  of  all  forms  of  tuberculosis  compulsory. 
This  means  that  English  cities  can  now  for  the  first  time 
tell  definitely  how  many  tuberculous  children  they  have  for 
whom  some  kind  of  provision  must  be  made  in  the  public 
schools.  The  estimate  of  the  examining  medical  officer  of 
London  is  that  at  least  10  per  cent,  including  the  anemics  and 
the  malnourished,  are  suitable  subjects  for  open-air  schools. 


OPEN-AIR   AND   OPEN- WINDOW   SCHOOLS  27 1 

Essentials  of  a  Community  Programme. — Most  commu- 
nities are  becoming  conscious  of  the  needs  of  their  school- 
children, and  are  endeavoring  to  create  forces  to  meet  these 
conditions.  In  The  School  Review  for  December,  1913,  Fred- 
erick L.  Hoffman  estimates  that  in  1913  12,229  deaths  among 
children  and  young  persons  of  school  age  occurred  in  the 
United  States  from  tuberculosis. 

First.  In  the  schools  of  every  large  city  will  be  found 
certain  children  who  have  open,  active  tuberculosis,  and  who 
need  sanatorium  care  where  the}^  can  be  given  continuous 
treatment  until  the  process  is  arrested.  A  part  of  each  com- 
munity's child-welfare  programme  should  include  a  sana- 
torium built,  equipped,  and  operated  to  serve  the  peculiar 
needs  of  children. 

Second.  There  will  be  other  children  who  should  have 
the  kind  of  care  that  is  afforded  in  the  hospital  school,  where 
the  health  of  the  child  is  the  paramount  issue,  and  the  aca- 
demic work  is  absolutely  secondary  and  tempered  carefully 
to  the  child's  physical  abilities.  Boston  has  such  a  school. 
It  is  run  under  the  auspices  of  hospital  authorities  and  in 
connection  with  a  hospital  sanatorium.  ''Such  a  place  is 
for  children  manifestly  tuberculous  who  ought  not  to  go  to 
the  regular  public  schools,  or  even  open-air  rooms,  and  yet 
who  are  not  sick  enough  to  require  bed  treatment  in  the 
hospital  sanatorium."  Some  of  the  children  go  only  for  the 
day,  others  stay  the  whole  week,  returning  Saturdays.  There 
are  many  children  of  this  t}pe  in  the  schools  of  a  large  city. 

Third.  There  should  be  open-air  schools  where  children 
may  go  during  the  regular  school  hours  daily.  These  schools 
should  have  outdoor  conditions  of  air,  and  the  children  should 
be  selected  and  supervised  in  accordance  with  the  medical  and 
nursing  regime  described  before.  Feeding,  rest,  and  careful 
co-operation  with  the  home  should  be  features  of  this  pro- 
gramme. This  school  will  deal  with  the  anemic  child,  with 
contact  cases,  and  with  children  who  are  predisposed  to  tu- 
berculosis. 


272  EDUCATIONAL  HYGIENE 

Fourth.  The  open-window  room.  Some  of  the  most 
advanced  cities  are  planning  to  have  such  a  room  in  every 
school.  To  these  rooms  the  children  who  need  special  con- 
sideration and  care  may  be  admitted.  The  temperature  in 
such  rooms  is  more  easily  modified,  but  the  air  can  be  kept 
fresh  and  invigorating  by  keeping  the  windows  open,  care 
being  taken  not  to  have  the  wind  blow  directly  on  the  chil- 
dren, and  to  see  that  additional  wraps  are  provided  and  that 
the  children  wear  these  wraps  when  they  need  them. 

It  seems  to  be  necessary  in  our  educational  processes 
to  learn  our  most  vital  lessons  from  defective,  delinquent, 
and  physically  subnormal  children.  Not  many  years  ago 
the  only  place  to  secure  manual  training  was  in  the  reform- 
atories or  correctional  institutions.  Madame  Montessori 
and  other  educators  have  taken  some  of  their  most  vital 
lessons  from  backward  children.  The  best  attendance  in 
the  Chicago  schools  during  a  recent  term  was  in  a  room 
fitted  up  with  manual-training  and  other  similar  devices  and 
to  which  a  lot  of  truant  boys  were  assigned. 

Any  community  that  will  provide  along  these  Hnes  for  its 
special  groups  of  children  will  in  the  process  have  learned 
that  such  facilities  are  also  good  for  normal  children.  The 
ultimate  aim  and  goal  of  the  open-air  school  movement  is 
nothing  short  of  right  conditions  of  sanitation,  hygiene,  and 
school  opportunity  for  the  20,000,000  boys  and  girls  in  the 
schools  of  the  United  States.  Children  should  not  neces- 
sarily be  sick  or  backward  or  wayward  to  enjoy  privileges 
and  processes  which  in  a  peculiar  way  appeal  to  child  nature 
and  satisfy  its  intrinsic  demands. 

Note. — See  the  writer's  volume  on  "Open  Air  Crusaders." — Ed. 


CHAPTER  XVI 
SCHOOL  FEEDING 

School  Feeding  as  an  American  Problem. — ^The  school 
lunch  has  always  been  an  important  part  of  our  American 
school  life.  The  noon  hour  plays  a  prominent  part  in  stories 
of  the  little  old  red  schoolhouse  of  former  days.  It  was 
then  that  the  pent-up  energy  of  social  longings  found  relief, 
and  the  most  enduring  companionships  were  formed.  Al- 
most all  of  the  young  people  stayed  at  the  school  during  the 
noon  hour  and  ate  lunch  together  because  few  of  them  lived 
near  enough  to  go  home.  This  condition  still  prevails  in 
rural  districts,  but  where  urbanization  has  taken  place  schools 
and  homes  have  been  brought  nearer  together  in  distance 
and  the  school  lunch  has  largely  disappeared. 

But  there  is  one  kind  of  school — the  high  school — in 
which  the  old  order  has  never  changed.  This  is  because  in 
towns  and  smaller  cities  there  is  usually  but  one  high  school, 
and  even  in  larger  cities  each  school  serves  a  large  district. 
The  consequence  is  that  the  children  have  a  long  way  to  go 
to  reach  their  homes,  and  so  we  have  developed  the  single 
session  extending  over  the  noon  hour  and  broken  by  a  short 
lunch  period.  As  a  result,  in  hundreds  of  high  schools  through- 
out the  land,  groups  of  young  people  numbering  from  a  score 
to  many  thousands  in  each  locaHty  are  every  day  confronted 
by  the  alternatives  of  going  hungry,  eating  a  lunch  brought 
from  home,  or  buying  one  near  or  in  the  school. 

How  the  High  School  Meets  the  Problem. — The  many 
ways  in  which  the  high  schools  meet  or  fail  to  meet  the  prob- 
lem may  be  summarized  under  the  two  headings  of  no  pro- 
vision and  supervised  provision,  either  indirect  or  direct. 

273 


274  EDUCATIONAL  HYGIENE 

The  first  method  is  rapidly  becoming  less  common. 
L'nder  it  the  school  authorities  pay  little  attention  to  what 
the  young  people  eat  during  the  lunch  period,  or  where  they 
eat  it,  so  long  as  they  do  not  annoy  the  teachers  or  litter  the 
premises.  The  results  are  socially  unwholesome  and  phys- 
iologically unhealthy.  The  breaking  of  bread  with  one's 
fellows  is  an  important  social  matter  and  the  conditions  sur- 
rounding it  should  be  as  comfortable  and  cheerful  as  circum- 
stances permit. 

The  health  considerations  are  more  important.  Where 
no  place  is  provided  in  which  the  boys  and  girls  can  eat  their 
lunches  conveniently  and  in  leisure,  there  is  every  temptation 
for  them  to  eat  nothing  at  all,  or  to  eat  Httle  and  bolt  that 
little  down  with  the  greatest  possible  speed. 

These  conditions  are  frequently  but  slightly  bettered 
when  the  school  authorities  sell  to  the  janitor  or  some  caterer 
the  privilege  of  maintaining  a  lunch-room  in  the  school  build- 
ing without  official  supervision  or  control. 

The  second  form  of  solution  came  into  being  when  Bos- 
ton, in  189^,  determined  to  grapple  with  the  high-school 
lunch  problem  and  solve  it.  In  that  year  Mrs.  Ellen  H. 
Richards  was  instrumental  in  getting  the  school  board  to 
decide  that  all  selling  and  serving  of  food  in  its  high  schools 
must  be  done  with  its  approval  and  under  its  supervision. 
.\n  arrangement  was  made  with  the  New  England  Kitchen 
through  which  wholesome  lunches  were  prepared  and  dis- 
tributed to  the  city  high  schools.  This  plan  was  successful, 
and  has  been  developed  until  at  present  the  fifteen  public 
high  schools  of  Boston  are  daily  supphed  with  lunches  pre- 
pared by  the  New  England  Kitchen  and  sold  to  the  students 
at  cost.  The  rooms  and  equipment  are  furnished  by  the 
city  and  a  committee  of  high-school  masters  supervises  the 
work.  .-Vt  [) resent  the  school  board  is  considering  taking  over 
the  lunch-rooms  for  direct  control. 

An  example  of  the  direct  provision  of  high-school  lunches 
is  furnished  by  Philadelphia,  where  the  work  in  every  school 


SCHOOL  FEEDING 


275 


is  financed  and  controlled  by  the  board  of  education.  The 
superintendent  of  this  lunch  system  has  the  rank  of  super- 
visor in  the  school  government.     She  is  an  expert  dietitian. 


Penny  Lunches 

bought 

at 

School  u4 

Cafories 

Penny  Lunches 

bought 

on 

Street 

Bean  Soup 

Sausa^e&Roll 

Rice  Pudding 

Pretzel 

Cocoa 

Cinnamon  Bun 

Milk 

Ice  Cake 

Ro^al  Lunch 

Marshmal  low  Cake 

Graham  Crackers 

g|  Popcorn  Roll 

Spice  Wafers 

H  Cand7  Ess 

Da-tes 

IB  Licorice 

Sweet  Chocolate 

H  Chocolate  l^ppermint 

Stick  Candy 

H  Candy  Roll 

RELATIVE  FOOD  VALUE  OF  SCHOOL  AND  STREET  LUNCHES 

The  left-hand  column  represents  the  food  value  of  a  penny  portion  bought 
at  school  when  a  charge  of  one-quarter  of  a  cent  is  made  for  service.  The 
right-hand  column  shows  the  food  value  of  the  amount  purchased  for  a  cent 
from  the  street  vendor,  who  makes  all  he  can  on  the  deal. 

At  school  the  amount  of  food  given  for  one  cent  is  always  as  high  as  possi- 
ble. Xn  the  street  the  child  can  buy  something  which  is  not  food  at  all,  like 
licorice. 


In  addition  to  supervising  the  preparation  of  the  lunches, 
she  spends  several  hours  daily  teaching  classes  about  food 
uses  and  values.  In  this  teaching  the  school  lunches  are 
used  as  examples  of  economical,  carefully  planned,  and 
wholesome  meals.  One  of  the  lessons  is  that  the  typical  lunch 
at  school,  costing  ten  cents,  gives  seven  hundred  calories, 
while  crullers  and  coffee,  a  common  meal  where  lunches  are 


276  EDUCATIONAL  HYGIENE 

unsupenised,  yields  but  two  hundred  and  fifty  calories  for  the 
same  price. 

Another  example  of  municipal  high-school  lunches  is 
afforded  by  Rochester.  Since  1903  the  two  high  schools  of 
that  city  have  conducted  lunch-rooms  directly  managed  by 
the  board  of  education.  The  kitchens  and  dining-rooms, 
instead  of  being  adapted  basements,  were  provided  for  in 
the  original  plans  of  the  buildings,  and  as  much  attention  was 
given  to  their  construction  and  location  as  was  devoted  to 
any  of  the  other  rooms. 

The  dining-rooms  are  light  and  airy,  open  to  the  direct 
rays  of  the  sun,  and  have  a  seating  capacity  of  one  thousand 
pupils  each.  The  kitchens  are  well  equipped  with  such  me- 
chanical contrivances  as  steam  cookers,  dish-washers,  and 
potato-peelers.  The  cooking  is  done  by  utilizing  the  waste 
steam  from  the  general  heating  plant,  so  that  there  is  no  extra 
expense  for  fuel.  An  experienced  dietitian,  appointed  by  the 
board  of  education,  superintends  the  entire  work  of  pur- 
chasing, preparing,  and  selling  the  food.  There  are  five 
workers  in  each  school  who  cook  and  serve  the  meals. 

These  lunch-rooms  are  entirely  self-supporting.  As  les- 
sons of  experience  have  made  the  work  more  efficient,  the  in- 
creasing profits  have  been  devoted  to  providing  more  food 
for  every  five-cent  piece  paid  by  students,  instead  of  turning 
the  extra  revenue  back  into  the  city  treasury.  The  result  is 
that  each  year  has  seen  an  increase  in  the  amount  of  food 
purchased  for  five  cents,  until  at  the  present  time  this  sum 
secures  for  the  children  generous  portions  of  well-cooked 
roast  beef  or  roast  lamb. 

Other  articles  of  food  are  correspondingly  cheap.  Soups 
cost  five  cents,  desserts  five  cents,  a  large  plate  of  macaroni 
with  cheese  and  bread  five  cents,  half  a  pint  of  certified  milk 
three  cents,  a  buttered  roll  one  cent,  and  a  bread-and-butter 
sandwich  one  cent. 

The  money  received  from  the  sale  of  food  at  these  prices 
covers  not  only  the  entire  cost  of  the  food  itself  but  that  of 


SCHOOL  FEEDING  277 

all  the  salaries  of  attendants  and  supervisors,  besides  the 
upkeep  of  equipment. 

The  work  done  in  Rochester  and  Philadelphia  is  perhaps 
more  highly  developed  than  is  general  elsewhere,  but  never- 
theless it  is  only  a  sample  of  what  many  cities  are  doing. 

Administration  of  High-School  Lunches. — The  New  York 
School  Lunch  Committee  in  a  recent  inquiry  found  that  of  68 
cities,  38  furnished  students  of  the  high  schools  with  lunches 
directly;  18  had  farmed  out  concessions  to  commercial  ca- 
terers; 7  allowed  co-operative  student  organizations  to  fur- 
nish lunches  under  supervision  of  the  board  of  education; 
and  in  5  cities  lunches  were  sold  by  private  philanthropic 
organizations,  such  as  women's  clubs,  etc.  In  practically  all 
cases  the  cities  supported  the  lunches  to  the  extent  of  the 
overhead  charges.  There  is  no  doubt  that  high-school 
lunches  are  to-day  practically  recognized  as  a  legitimate  part 
of  pubHc-school  provisions. 

The  general  features  of  administration  in  sixteen  typical 
cities  are  shown  in  the  following  summary  based  on  data 
gathered  by  the  Committee  on  High  School  Lunches  in  Bos- 
ton in  1913.  The  cities  included  are:  Brookl}^,  New  York, 
Buffalo,  Rochester,  Springfield,  Fairhaven,  Newton\'ille, 
Philadelphia,  Pittsburgh,  Cincinnati,  St.  Louis,  Kansas  City, 
Grand  Rapids,  Minneapolis,  Omaha,  and  Seattle. 

In  all  these  cities  the  financial  risk  is  finally  lodged  with 
the  school  board.  Immediate  responsibility  for  administra- 
tive detail  rests  with  the  domestic-science  department  in 
eight  cities.  In  five  cities  the  work  is  controlled  by  a  special 
committee  of  the  board.  In  two  cities,  where  only  one  high 
school  has  the  lunch,  the  work  is  directed  by  members  of  the 
faculty;  and  in  the  remaining  city  by  the  High  School  Students' 
Association. 

In  a  number  of  cities  they  had  first  tried  out  the  experi- 
ment of  having  janitors  or  caterers  serve  the  lunches,  but  in 
four  cities  where  the  work  is  relatively  new  it  was  begun  im- 
mediately under  school-board  control.    In  St.  Louis  and  three 


27S  EDUCATIONAL   HYGIENE 

Other  cities  the  school-luncheon  work  is  under  the  supervision 
of  the  domestic-science  department,  and  cooking  classes  oc- 
casionally provide  food  for  the  lunch-room.  This  works  out 
particularly  well  in  the  smaller  cities  where  the  numbers  are 
not  so  large — as,  for  example,  in  Newtonville,  Mass.  In  at 
least  one  case  the  money  is  handled  by  the  commercial  de- 
partment of  the  high  school.  In  Philadelphia  the  superin- 
tendent of  lunches  gives  talks  at  the  different  high  schools  on 
lunches  and  dietetic  principles  involved. 

There  has  been  practically  no  attempt  to  connect  the  work 
in  the  high  schools  with  the  health  department,  though  this 
connection  is  an  important  feature  of  the  lunches  in  ele- 
mentary schools.  In  Pittsburgh  this  was  proposed  and  ap- 
proved by  the  board,  but  had  not  been  put  in  operation  ac- 
cording to  the  last  report.  In  only  one  city  was  the  director 
reported  as  not  specially  trained  for  the  work.  In  thirteen 
cities  the  superintendent  of  lunches  ranks  as  a  regular 
school  officer,  being  either  supervisor  or  a  member  of  the 
faculty. 

In  nearly  all  the  cities  the  surplus  is  designed  for  im- 
proving the  lunches  themselves,  as,  for  example,  reducing  the 
price  of  foods  served  or  buying  new  equipment.  In  a  few 
cities,  however,  the  money  is  returned  to  the  general  school 
fund,  and  in  Springfield  it  is  turned  in  to  a  common  revenue 
fund  for  the  city. 

It  is  practically  a  universal  custom  to  charge  enough  for 
the  lunches  to  cover  food  and  service.  In  a  majority  of  cases 
enough  is  charged  to  cover  the  cost  of  ice,  the  upkeep  of 
equipment,  and  repairs.  The  cost  of  superintendence  is 
covered  in  eight  cases,  and  fuel  in  five.  Light,  heat,  rent, 
and  water-rates  are  not  included  in  the  cost. 

The  School-Lunch  Problem  in  Elementary  Schools. — The 
essential  features  of  the  planned  and  supervised  lunch  in  the 
best  high  schools  are  that  the  child's  need  is  provided  for,  the 
food  is  sold  at  cost,  and  it  is  wholesome  and  well  served.  The 
lunch-rooms  arc  cheerful,  pleasant,  and  sanitary,  and  the  work 


4 


SCHOOL   FEEDING  279 

is  under  responsible  management.  Moreover,  there  is  no 
compulsion,  actual  or  implied,  put  on  any  child  to  buy  the 
school  lunch — he  is  simply  given  the  opportunity. 

The  question  that  school  workers  are  now  asking  is:  Wh}- 
cannot  the  same  benefits  be  secured  for  the  vastly  larger- 
number  of  elementary-school  children?  In  the  smaller  towns 
and  country  districts  the  younger  children  face  the  same  noon 
problem  as  their  older  brothers,  with  the  difference  that  they 
have  a  longer  afternoon  session  of  work  ahead.  In  mill  and 
factory  towns  and  in  the  poorer  districts  of  the  large  cities, 
even  when  the  children  go  home  at  noon,  there  is  frequently 
no  one  there  to  prepare  lunch.  Both  father  and  mother  are 
absent  at  their  work.  Moreover,  ignorance  about  nutritive 
food  and  its  preparation  is  so  dense  and  so  wide-spread  that 
thousands  of  children  start  for  school  in  the  morning  after  a 
totally  insufficient  breakfast  consisting,  for  instance,  of  coffee 
and  bread,  and  taking  with  them  a  few  pennies  to  buy  lunches 
in  the  shops  near  the  school.  In  consequence  they  must  wait 
until  night  before  they  get  a  real  meal. 

The  fact  that  more  than  fourscore  cities  are  already  tak- 
ing steps  to  meet  this  problem  shows  that  it  is  real,  wide- 
spread, and  serious  in  degree.  The  first  question  which  con- 
fronts every  one  of  these  cities,  as  well  as  the  others  which 
have  not  yet  begun  to  provide  for  school  lunches  in  elementary 
schools,  is  whether  or  not  this  work  is  a  legitimate  function  of 
the  board  of  education. 

Objections  to  School  Feeding. — When  the  project  of  in- 
augurating school  feeding  in  elementary  schools  is  proposed 
to  the  taxpayer,  the  citizen,  or  the  school  man,  the  immediate 
reaction  is  almost  always  one  of  opposition.  The  expression 
of  this  opposition  takes  many  forms,  among  which  the  fol- 
lowing arguments  are  usually  prominent.  School  feeding,  it 
is  claimed,  would  further  complicate  the  already  intricate 
systems  of  public  education;  it  would  add  to  the  work  of 
already  overburdened  teachers.  The  providing  of  school 
meals  would  tend  to  lessen  the  responsibility  of  the  home  and 


28o  EDUCATIONAL  HYGIENE 

SO  undermine  the  foundations  of  family  life.  If  meals  are 
provided  at  all,  they  tend  to  become  not  only  free  but  uni- 
versal, which  would  result  in  pauperizing  the  community. 
As  some  children  would  receive  meals  and  others  not,  the 
system  would  tend  to  promote  undesirable  distinctions  among 
the  children.  If  children  are  genuinely  underfed  at  home,  the 
provision  at  school  of  one  meal  per  day  will  not  solve  the  prob- 
lem of  their  proper  nourishment. 

The  foregoing  arguments  are  the  most  important  of 
those  commonly  urged  against  school  feeding  and  are  fairly 
typical  of  the  rest.  On  careful  analysis,  all  of  these  argu- 
ments fall  into  two  classes.  In  the  first  come  those  objec- 
tions which  form  one  or  another  feature  of  the  general  argu- 
ment that  the  providing  of  food  is  not  a  legitimate  function  of 
a  department  of  education.  The  objections  of  the  second 
class  include  arguments  that  school  feeding  is  socially  danger- 
ous. It  seems  worth  while  briefly  to  consider  whether  or  not 
the  objections  against  school  feeding  are  so  important  and 
valid  as  permanently  to  exclude  it  from  among  the  possible 
activities  of  the  modern  socialized  school. 

To  the  first  objection,  that  furnishing  food  is  not  a  legiti- 
mate function  of  a  department  of  education,  it  may  be  answered 
that  under  our  systems  of  compulsory  education  the  power 
to  force  every  child  to  attend  school  carries  with  it  the  duty 
of  making  it  possible  for  every  child  to  learn.  If  the  child  is 
so  hungry  that  he  cannot  learn,  some  means  must  be  pro- 
vided whereby  he  shall  be  fed.  Hunger  is  a  stern  condition, 
not  a  social  theory.  It  cannot  be  met  through  the  offering  of 
a  geography  or  a  grammar.  It  is  clear  that  where  social  con- 
ditions exist  which  involve  the  presence  in  school  of  large 
numbers  of  unfed  or  underfed  children,  it  is  the  function  of 
the  school  to  see  to  it  that  some  means  be  provided  whereby 
these  children  can  obtain  food  in  order  that  they  may  be  in 
condition  to  obtain  knowledge.  This  does  not  necessarily 
involve  provision  by  the  school  itself.  It  does  involve  the 
facing  of  the  problem  and  the  securing  of  some  solution 
for  it. 


SCHOOL  FEEDING  251 

The  arguments  of  the  second  class  claim  that  school  feed- 
ing is  socially  dangerous,  that  it  tends  to  undermine  the  re- 
sponsibility of  the  home,  and  that  it  results  in  governmental 
paternalism. 

There  is  one  nearly  universal  fallacy  in  the  reasoning  that 
lies  behind  these  arguments.  This  is  the  assumption  that 
any  form  of  school  feeding  means  the  free  proxdsion  of  meals 
for  all  children.  This  assumption  is  unwarranted  by  the 
facts  either  here  or  abroad.  Such  work  as  that  already  de- 
scribed as  being  carried  on  in  the  high  schools  of  Rochester, 
Boston,  Philadelphia,  and  other  great  cities  has  no  remote 
suggestion  of  the  dispensation  of  alms.  What  it  does  provide 
is  the  opportunity  to  purchasjejdiQlesome  food  at  cost  This 
is  what  school  feeding  in  America  has  meant  up  to  the  present 
time  and,  so  far  as  we  can  foresee,  it  is  in  the  main  what  it 
will  continue  to  mean.  Moreover,  it  is  in  large  measure  what 
school  feeding  means  abroad. 

Elementary-School  Feeding  and  Medical  Inspection  Anal- 
ogous.— There  is  a  close  analogy  between  the  extension  of  the 
school's  acti\dties  to  provide  an  opportunity  for  purchasing 
food,  and  the  existing  systems  of  medical  inspection  which 
examine  children  and  notify  the  parents  of  the  steps  which 
need  to  be  taken  to  put  them  in  such  physical  condition  that 
they  can  benefit  by  the  free  education  provided  by  the  State. 
Both  are  extensions  of  social  machinery  which  provide  oppor- 
tunity for,  but  do  not  supply  the  remedy  for,  the  wrong  condi- 
tion found.  The  sort  of  school  feeding  which  we  are  discuss- 
ing provides  machinery  for  finding  out  which  children  need 
food,  and  for  giving  their  parents  an  opportunity  of  remedy- 
ing the  situation  by  purchasing  food  at  cost.  In  the  same  way, 
medical  inspection  examines  the  children  and  discovers  exist- 
ing defects,  but  does  not  remedy  those  defects.  It  simply  gives 
the  parents  an  opportunity  of  knowing  of  existing  conditions 
and  it  points  out  the  remedy.  Public-school  clinics  and  other 
forms  of  public  treatment,  of  course,  are  rapidly  entering  the 
field  of  free  treatment,  but  for  the  most  part  municipal  clinics 
restrict  free  treatment  to  those  in  destitute  circumstances. 


282  EDUCATIONAL  HYGIENE 

In  stating  that  the  establishment  of  school  feeding  means 
the  provision  of  opportunity  to  purchase  wholesome  food  at 
cost,  it  would  be  misleading  to  overlook  the  fact  that  there 
will  always  be  some  children  in  the  poorer  sections  of  our 
great  cities  who  are  genuinely  indigent  and  to  whom  meals 
must  be  furnished  free,  if  they  are  to  be  furnished  at  all. 
There  is  nothing  new  about  this  situation,  nor  does  it  present 
any  insurmountable  difficulties.  In  every  State  and  city  where 
school  text-books  are  purchased,  there  have  been  in  force  for 
many  years  different  regulations  for  providing  books  free  of 
cost  to  children  unable  to  purchase  them.  The  machinery  for 
solving  the  same  problem  with  respect  to  meals  has  been 
brought  to  a  high  state  of  perfection  in  several  European  coun- 
tries, though  little  has  been  done  to  meet  it  here. 

In  America  the  school-lunch  movement  which  has  had  an 
astonishing  development  in  the  last  five  years  is  character- 
ized by  the  absence  of  the  relief  element.  Although  a  large 
proportion  of  our  school-children — 10  per  cent  by  conservative 
estimate,  25  per  cent  by  more  liberal  interpretation — are  suf- 
fering from  malnutrition,  the  rehef  of  this  condition  is  not 
the  primary  aim  of  those  advocating  school  meals.  It  is 
the  conviction  of  American  school  men  that,  if  the  school  is 
to  assume  responsibility,  it  must  be  because  of  educational 
considerations  affecting  100  per  cent  of  the  children.  This 
conviction  was  expressed  again  and  again  during  the  school 
feeding  session  at  the  Fourth  International  Congress  on  School 
Hygiene  at  Buffalo  in  August,  1913. 

Administration  of  Lunches  in  Elementary  Schools. — 
Within  the  last  five  years  the  movement  for  extending  the 
benefit  of  warm  lunches  served  at  cost  to  the  children  in  the 
elementary  schools  has  spread  from  five  to  ninety  cities  in 
twenty-eight  States.  While  in  the  larger  number  of  instances 
the  work  has  been  inaugurated  by  private  organizations,  such 
as  women's  clubs,  home  and  school  associations,  and  so  forth, 
it  has  been  always  with  the  moral  support  of  the  school  au- 
thorities and  personal  co-operation  of  members  of  the  school 


u 


SCHOOL  FEEDING  283 

governments,  in  addition  to  financial  help  in  the  way  of  over- 
head charges  and  fuel.  As  in  the  case  of  the  high  schools, 
there  is  a  distinct  tendency  to  regard  the  work  of  the  private 
organizations  as  preliminary  demonstration  of  methods  fea- 
sible for  use  by  the  school  boards  when  they  assume  entire 
responsibility.  According  to  Edward  F.  Brown,  executive 
secretary  of  the  New  York  School  Lunch  Committee,  out  of 
sixty  cities  thirty-five  were  serving  meals  under  the  jurisdic- 
tion of  the  school  board. 

The  essential  features  of  the  administration  of  the  work 
in  New  York,  which  dates  from  1908,  are  as  follows:  There  is 
a  committee  of  eighteen  men  and  women,  including  school- 
board  members,  medical  inspectors,  social  workers,  and  mem- 
bers of  the  faculty  of  Columbia  University.  The  chairman  is 
an  experienced  dietitian  and  social  worker.  The  superin- 
tendent is  a  graduate  dietitian  with  experience  in  teaching 
and  dietetic  social  service  in  a  hospital.  The  buying,  and  the 
engaging  and  direction  of  cooks  and  helpers,  are  in  her  hands. 
There  are  seventeen  schools  supplied  with  lunches  at  noon 
from  four  central  kitchens.  A  year  of  experience  with  central 
kitchens  has  demonstrated  their  greater  economy  and  effi- 
ciency as  compared  with  separate  kitchens.  The  only  limit  to 
centralization  of  kitchens  is  made  by  the  necessity  of  provid- 
ing different  menus  for  schools  with  attendance  of  different 
nationalities.  Thus,  separate  provision  is  made  for  Italian, 
Jewish,  and  Irish-American  children.  This  is,  however,  dis- 
tinctly a  problem  of  very  large  cities. 

The  cooks  are  employed  for  the  whole  of  each  school  day 
at  a  weekly  wage  of  ten  dollars.  Under  the  superintendent 
are  a  corps  of  paid  supervisors  who  are  present  two  hours 
daily  at  each  school  to  see  to  the  preparation,  selling,  and  dis- 
tribution of  food.  The  actual  serving  of  the  food  is  done  by 
pupil  monitors  who  wear  white  aprons,  caps,  and  gloves. 
These  helpers  receive  their  lunches  free. 

Owing  to  the  large  numbers,  and  lack  of  special  dining- 
room  provision,  the  children  eat  their  lunches  standing  at 


284  EDUCATIONAL  HYGIENE 

long  tables  erected  in  the  basement.  Each  child  must  pur- 
chase the  main  dish,  a  bowl  of  soup,  before  being  allowed  to 
get  the  penny  extras  served  at  a  separate  table.  The  kind 
of  soup  varies  with  the  predominant  nationality  of  the  chil- 
dren. Examples  of  soups  served  in  the  American  districts 
are:  split  pea,  tripe,  clam  chowder,  vegetable,  Scotch  broth, 
and  macaroni.  The  food  value  varies  from  74  to  148  calories. 
In  the  Jewish  schools  the  food  is  heavier  and,  to  avoid  offend- 
ing the  laws  of  kosher,  entirely  without  meat,  as:  potato  and 
barley,  lentils  and  rice,  lima  beans  and  barley,  rice  and  milk, 
Obergritz  and  potatoes,  noodles  and  milk.  The  average  num- 
ber of  calories  here  is  190.  In  the  Italian  schools  the  special 
dishes  are  menestra,  rice  and  tomato,  beans  and  pasta,  maca- 
roni, and  rice  with  cheese  and  tomato.  The  average  number  of 
calories  is  138. 

After  the  child  has  bought  the  soup  he  goes  to  the  extra 
table,  where  he  may  purchase  one  or  two  other  things  at  a 
penny  apiece.  Among  the  extras  are:  sandwiches  with  jam, 
egg,  onion,  lettuce,  meat,  bologna,  and  cheese;  potato,  cab- 
bage, tomato,  or  lentil  salad;  bread,  chocolate,  or  rice  pudding; 
cocoa;  sweet  chocolate  squares;  crackers,  jelly  cake;  ice- 
cream; grapes,  bananas  sliced  with  milk,  prunes,  apple  sauce, 
baked  apple,  apple  sugared  on  stick. 

A  child  spending  three  cents  at  these  tables  gets  from 
one-third  to  one-half  of  the  total  amount  of  food  he  needs 
during  the  day. 

Feeding  in  Open-Air  Classes. — In  classes  for  tuberculous, 
anemic,  and  convalescent  children  the  lunches  are  as  much  a 
part  of  the  treatment  as  the  fresh  air  itself.  The  meals  are 
more  elaborate  than  is  usual  in  the  regular  schools,  and  they 
are  more  frequent.  The  following  menu  is  typical  of  the 
American  practise: 

Breakfast:    Cocoa,  graham  gems,  butter,  stewed  prunes. 
Lunch:    Stew  of  rice  and  mutton,  or  creamed  codfish,  mashed 
potato,  bread  and  butter,  milk,  dates  or  figs. 

Supper:   Milk,  crackers  and  cream  cheese,  or  preserved  fruit. 


SCHOOL  FEEDING  285 

These  meals  supplement  the  home  meals.  Counting  in  the 
average  home  meals,  the  children  consume  as  much  as  2,500 
calories,  which  would  be  far  too  high  for  normal  children  but 
not  for  these  whose  metabolism  is  overactive  or  deranged. 

Lunches  in  Rural  Schools. — One  reason  that  health  con- 
ditions in  rural  schools  have  been  so  long  neglected  is  because 
of  the  common  idea  that  country  children  are  naturally  vigor- 
ous and  healthy.  "This  ought  to  be  so  but  unfortunately  is 
not,"  says  Doctor  Ernest  Hoag,  in  a  recent  government  re- 
port. He  finds  that,  "in  general,  food  is  not  as  well  prepared 
in  the  country  as  it  is  in  the  city;  the  available  variety  is 
smaller."  Bad  methods  of  ventilation  and  heating  at  home 
and  at  school,  exposure  to  wet  in  the  long  walks  to  school, 
and  overdressing  in  the  house — all  are  inroads  on  the  already 
badly  nourished  bodies.  Investigations  show  that  malnu- 
trition and  its  accompanying  diseases  are  quite  as  frequent 
among  country  as  among  city  children.  Steps  to  remedy  this 
condition  are  being  taken  in  New  Hampshire,  Washington, 
Nebraska,  South  Dakota,  Texas,  and  Minnesota;  in  the  last 
two  cases,  under  the  direction  of  the  State  universities.^ 

The  equipment  necessary  for  the  rural-school  lunch  need 
not  be  more  elaborate  than  a  top  for  the  stove  used  for  heat- 
ing, some  pots,  cups  and  spoons,  and  wash-basin  and  towels. 
The  preparation  and  service  can  be  done  by  the  children  in 
turn,  and  is  an  excellent  adjunct  to  domestic-science  lessons. 
Frequently  a  single  warm  dish,  like  soup  or  stew,  or  cocoa,  is 
prepared  to  supplement  the  cold  lunches  brought  from  home. 
The  two  essentials  are  warmth  and  the  presence  of  protein, 
as  the  lunches  brought  by  the  children,  as  well  as  their  home 
diet,  are  apt  to  be  overrich  in  starches  and  sugars.'^ 

The  Place  of  Nutrition  in  the  School  Hygiene  Movement, 
— In  1867  M.  Dupre,  Commissioner  of  Education  in  France, 

*  See  report  of  Doctor  Thos.  D.  Wood  to  National  Education  Association 
in  February,  1915. 

^  See  Andrew's  "  Education  for  the  Home,"  part  two,  section  two,  bulletin 
61 1  of  the  U.  S.  Bureau  of  Education. 


286  EDUCATIONAL  HYGIENE 

recommended  to  the  local  directors  that  they  look  into  the 
health  of  their  pupils  and  pay  particular  attention  to  their 
nutritional  condition.  This  is  the  first  time  that  an  official 
concern  for  the  nutrition  of  school-children  was  recorded  in 
any  country,  although  it  does  not  mark  the  beginning  of  school 
feeding.  School  funds  for  the  support  of  extra-academic 
activities,  such  as  lunches  and  baths,  were  made  general 
throughout  France  as  a  result  of  M.  Dupre's  suggestion,  and 
in  1882  the  "Caisses  dcs  Ecoles"  were  made  compulsory  along 
with  general  primary  education. 

In  1872  a  municipal  law  in  Munich  called  for  a  kitchen 
and  dining-room  in  all  new  school  buildings.  This  was  an 
official  recognition  of  work  which  began  as  a  relief  measure  in 
1792.  In  1890  the  school  feeding  movement  in  Germany  re- 
ceived national  recognition  at  a  congress  of  vacation  colony 
workers,  where  it  was  decided  that  the  good  results  of  sending 
children  to  the  country  in  summer  were  more  than  counter- 
balanced by  the  evils  of  bad  feeding  throughout  the  year. 
In  1909  the  National  Society  for  People's  Welfare,  in  a  three 
days'  conference,  reported  on  work  in  half  the  German  cities 
and  in  many  rural  districts. 

In  England,  between  1866  and  1905,  largely  through  the 
efforts  of  teachers,  no  less  than  three  hundred  and  sixty  sepa- 
rate societies  were  organized  for  the  relief  of  acute  distress  re- 
sulting from  hunger.  The  agitation  over  "physical  deteriora- 
tion" in  England,  from  1902  to  1906,  resulted  in  the  discovery 
of  malnutrition  during  the  growing  period  as  an  important 
factor  in  the  lowering  of  the  national  fitness.  The  first  act  of 
legislation  to  grow  out  of  this  agitation  was  the  Provision  of 
Meals  Act,  which  gave  the  local  educational  authorities  per- 
mission to  install  school  restaurants  as  part  of  the  regular 
school  equipment. 

Malnutrition  and  Medical  Inspection. — Recently  there 
has  been  an  increasing  tendency  to  make  the  report  on  nu- 
trition of  different  children  the  basis  of  the  entire  medical- 
insjjection  report.    This  is  because  it  has  been  demonstrated 


SCHOOL   FEEDING  287 

again  and  again  that  the  occurrence  of  disease  and  physical 
defects  is  largely  conditioned  by  nutritional  disturbances. 

In  Paris  medical  inspectors  have  charge  of  the  school 
canteens  and  are  required  to  report  on  the  nutrition  of  each 
child.  They  are  further  expected  to  follow  up  any  child 
with  impaired  nutrition  and  to  administer  tonics  and  special 
care. 

In  England,  since  1907,  compulsory  medical  inspection 
has  included  inspection  of  nutrition.  Beginning  with  1909, 
the  chief  medical  ofificer  of  the  National  Board  of  Education 
has  reported  yearly  on  the  nutrition  of  the  children  through- 
out the  country  and  on  the  work  of  the  school  feeding  centres. 
In  Scotland  the  medical  inspectors  are  required  to  see  that 
children  suffering  from  malnutrition  are  fed  properly  either 
by  the  school  or  by  the  parents.  As  a  result  of  this  system- 
atic work  British  school  doctors  are  developing  methods  of 
technique  and  standards  for  judging  malnutrition,  which,  on 
account  of  its  complex  and  interwoven  causes,  is  very  difficult 
to  estimate  accurately. 

*  The  correlation  of  disease  and  malnutrition  is  every- 
where acknowledged.  It  has  been  worked  out  with  scientific 
accuracy  by  Doctor  Gastpar,  of  Stuttgart,  who  from  1906  to 
191 2  examined  65,000  children,  making  a  thorough  physical 
and  medical  examination,  and  then,  dividing  the  children 
into  five  different  nutritional  groups,  determined  the  propor- 
tion of  disease  and  defects  in  each  group.^  Briefly,  his  results 
were  as  follows:  If  the  children  in  the  best-nourished  group, 
who  numbered  13,229,  were  compared  with  those  of  the  worst- 
nourished  group,  who  numbered  15,807,  it  was  found  that 
among  100  well-nourished  children  there  were  j6  defects, 
whereas  among  100  badly  nourished  children  there  were  iS^ 
defects.  The  defects  noted  in  this  summary  were:  scoliosis, 
diseased  glands,  tuberculosis,  heart-trouble,  eye  defects,  ear 

^  For  a  preliminary  report  of  this  work  see  Zeitsckrift  ftir  Schulgesund- 
heitspflege,  vol.  21,  1908,  pp.  689-702.  A  detailed  account  of  the  entire  in- 
vestigation is  in  preparation  by  the  author  of  the  present  paper. 


2S8  EDUCATIONAL  HYGIENE 

defects,  albuminuria,  and  anemia.  As  the  badly  nourished 
all  had  anemia,  it  would  be  perhaps  fairer  to  call  anemia  part 
of  the  nutritional  condition  rather  than  a  separate  defect. 
In  this  case  there  would  be  8s  dejects  to  every  loo  badly  nour- 
i>hiHl.  anemic  children  instead  of  iSj  dejects. 

The  Classification  of  Nutrition. — Doctor  Gastpar's  method 
of  classif)ing  nutrition,  which  is  known  as  the  group  method, 
is  one  of  the  most  satisfactory  yet  devised  for  working  use. 
It  is  briefly  as  follows: 

(i)  There  is  first  an  individual  examination  of  each  child, 
in  which  measurements  of  height  and  weight  are  taken,  and 
the  state  of  nutrition  determined  by  these  and  other  factors, 
such  as  the  state  of  the  superficial  circulation,  the  muscula- 
ture, skin  tonicity,  the  condition  of  the  mucous  membrane, 
the  expression  of  the  eyes  and  the  entire  face,  the  roughness 
or  smoothness  of  the  hair,  etc.  At  the  same  time  other 
physical  defects  are  noted  that  may  bear  upon  nutrition,  as 
the  condition  of  the  teeth,  presence  of  adenoids,  and  particu- 
larly the  presence  or  absence  of  anemia. 

(2)  After  these  records  have  been  made  for  each  individual 
child,  the  children  are  then  divided  according  to  their  ages. 
Then  the  children  of  each  group  are  divided  into  those  having 
anemia  and  those  without  it.  These  two  groups  are  further 
subtlivided  until,  in  order  of  nutritional  excellence,  children 
in  each  age-group  stand  thus:  (a)  good;  {h)  fair;  (c)  fair  with 
anemia;  (d)  poor;  (c)  poor  with  anemia. 

Experience  in  the  application  of  this  plan  of  classifica- 
tion has  developed  three  general  rules  that  are  valid  for  ap- 
plication in  any  country.     Briefly  these  rules  are  as  follows: 

(a)  Every  child  is  examined  separately  in  a  room  specially 
provided,  where  the  light  and  temperature  may  be  regulated. 

{h)  One  physician  should  make  all  the  examinations  for 
any  given  grouj)  of  children. 

(c)  The  examining  physician  should  be  familiar  with  the 
racial  peculiarities  of  growth,  complexion,  and  coloring. 

This  system  involves  time  and  care,  but  it  insures  a  fair 
flegrce  of  accuracy  in  a  subject  not  easy  to  define  rigidly. 


SCHOOL  FEEDING  289 

Some  such  scheme  is  absolutely  necessary  if  experience  is  to 
be  shared.  This  has  been  found  specially  valuable  in  record- 
keeping, and  in  finding  the  correlation  between  the  state  of 
nutrition  and  other  physical  conditions. 

Extent  of  Malnutrition  among  School-Children. — Until 
the  practise  of  measuring  nutrition  by  some  such  standard  as 
that  outlined  above  becomes  more  general,  the  present  dis- 
crepancies in  reports  as  to  the  exact  extent  of  malnutrition 
among  school-children  will  continue.  In  American  cities  no 
record  of  the  nutrition  of  the  entire  school  population  has  been 
made.  In  1907  in  New  York  the  Committee  on  Physical 
Welfare  of  School-Children  reported  13  per  cent  of  990  chil- 
dren, selected  as  typical  of  the  whole  city,  to  be  suffering  from 
malnutrition.  A  similar  investigation  of  10,090  children  in 
Chicago  in  1908  revealed  12  per  cent  badly  nourished  in  all 
grades,  the  proportion  decreasing  from  15  per  cent  in  the 
kindergarten  to  6  per  cent  in  the  fifth  grade  and  above. 
Wherever  an  attempt  has  been  made  to  include  all  classes  of 
children  in  the  examinations,  the  percentages  found  suffering 
from  acute  malnutrition  run  from  10  to  15.  Where  only 
schools  in  the  poorer  districts  are  included,  the  percentages 
are  far  higher,  and  vary  between  20  and  40.  However,  it 
must  be  remembered  that  children  from  the  poorer  districts 
far  outnumber  those  in  other  schools,  so  that  in  point  of  figures 
the  actual  proportion  of  children  suffering  from  malnutrition 
is  probably  nearer  the  second  estimate.  Doctor  Thomas  F. 
Wood,  of  Columbia,  gives  25  per  cent  as  the  estimate  for  the 
school  population  of  the  whole  country. 

"The  longer  a  medical  officer  remains  at  school  inspec- 
tion," remarks  Doctor  Hope,  of  Liverpool,  in  a  report  for 
1912,  "the  more  severe  becomes  his  standard  of  nutrition, 
and  the  less  readily  does  he  pass  a  child  as  being  well  nour- 
ished." 

The  truth  of  this  is  shown  in  the  British  reports,  which 
from  year  to  year  show  in  the  aggregate  an  increasing  pro- 
portion of  children  grouped  in  the  division  of  subnormally 
nourished.     In  191 1  the  average  per  cent  reported  was  11 


290 


EDUCATIONAL  HYGIENE 


for  twenty-three  communities;  in  191 2  the  average  for  twenty- 
seven  cities  was  13.  The  percentages  from  the  different 
places  varied  from  3  to  30. 

In  Stuttgart  all  the  children  were  examined  during  sj:;: 
successive  years,  and  classified  according  to  the  Gastpar 
method  described.  Out  of  65,000,  24  per  cent  fell  in  the 
group  of  "poorly  nourished,  with  anemia,"  and  only  20  per 
cent  merited  the  grouping  "good." 

Malnutrition  and  Retardation. — -In  an  address  before  the 
superintendents'  section  of  the  National  Education  Associa- 
tion in  1913.  Superintendent  Francis,  of  Los  Angeles,  gave  as 
his  opinion  that  a  systematic  provision  of  lunches  in  the 
schools  would  greatly  reduce  the  cost  of  retardation.  Princi- 
pals of  Philadelphia  schools  have  reported  a  substantial  reduc- 
tion in  afternoon  truancy  following  the  introduction  of  lunches. 
In  1894  lunches  were  introduced  into  Milan  schools,  where 
the  average  daily  attendance  was  only  72  per  cent  of  the  en- 
rolment. This  percentage  increased  after  the  introduction 
of  the  lunches  to  94  per  cent  in  1905.  A  survey  of  the  fac- 
tors making  for  non-promotion  in  Manchester,  Connecticut, 
showed  that  of  all  the  children  who  failed  of  promotion  25  per 
cent  were  suffering  from  malnutrition  as  opposed  to  9  per 
cent  among  those  promoted. 

Among  mentally  defective  children,  the  proportion  that 
are  badly  nourished  is  reported  in  Germany,  England,  and 
this  country  as  being  from  60  to  65  per  cent.  Lunches  are 
being  introduced  into  the  special  classes  as  a  partial  remedy 
for  this  condition. 

Planning  of  Dietaries.— The  problems  of  school  dietaries 
are:  first,  how  to  assure  the  children  a  lunch  that  shall  satisfy 
the  appetite,  yield  a  fair  proportion  of  the  day's  total  ration, 
and  make  up  for  deficiencies  of  protein  and  fat  found  in  tbf 
children's  home  diets;  and,  second,  how  to  do  all  this  while 
keeping  the  cost  of  food,  preparation,  and  service  within  the 
ability  ()f  the  children  to  pay.  It  must  be  remembered  that 
the  ( hildrt-n's  unit  of  payment  is  a  cent. 


SCHOOL  FEEDING  29 1 

This  problem  has  been  most  satisfactorily  solved  in 
Bradford,  England,  where  the  meals  are  so  well  planned  and 
conducted  as  to  serve  as  a  model  not  onlv  for  England  but 
for  us  as  well.  There  are  seventeen  dinner  menus  served  in 
rotation,  thus  providing  the  very  necessary  variety.  A  sam- 
ple dinner — meat  pie,  bread,  green  peas,  gravy,  and  stewed 
fruit — -yields  a  total  fuel  value  of  894  calories,  with  33  grams 
of  tissue-building  protein,  21  grams  of  fat,  and  168  grams  of 
starch  and  sugar.  The  cost  of  this  meal  to  the  city,  including 
superintendence,  preparation,  and  service,  is  three  cents, 
and  this  is  what  the  children  pay. 

Experience  in  planning  dietaries  in  different  countries 
indicates  that  if  the  ration  is  in  accordance  with  the  needs  of 
the  average  ten-year-old  child  weighing  sixty  pounds,  this  may 
be  varied  up  and  down  quite  easily  for  the  older  and  younger 
children.  The  following  is  a  practical  basis  for  a  plan  of  the 
whole  day's  needs: 

Protein 60  grams  yielding     240  calories. 

Fats 40  grams  yielding     360  calories. 

Carbohydrates 250  grams  yielding  1,000  calories. 

Total 350  grams  yielding  1,600  calories. 

The  nutritive  ratio  of  this  dietary  is  i  to  4.8. 

A  study  of  the  food  values  of  the  lunches  in  use  in  well- 
organized  systems  of  school  feeding  in  England,  Switzerland, 
and  Germany  indicates  that  they  furnish  over  one-half  of  the 
day's  total  ration — a  little  over  one-half  of  the  protein  an^^^ 
not  quite  half  of  the  fat. 

Money  Value  and  Food  Value. — If  there  is  no  school  lunch 
provided,  a  large  and  growing  proportion  of  the  children  buy 
their  own  lunches  from  venders  at  the  door,  and  at  near-by 
shops.  The  average  value  of  one-cent  lunches  in  Philadel- 
phia is  114  calories;  children  buying  of  the  venders  are  able 
at  best  to  get  only  52  calories.  Moreover,  the  street  food  is 
unclean  and  in  many  cases  adulterated.  Most  school  princi- 
pals and  teachers  have  met  with  the  serious  and  pernicious 


292  EDUCATIONAL  HYGIENE 

influence  of  the  cheap,  adulterated  candy  and  pastry  sold  at 
the  inevitable  parasitic  "little  candy  store"  near  most  schools. 

Present  Extent  of  the  School  Feeding  Movement.— 
Lunches  in  the  elementary  schools  form  part  of  the  regular 
educational  provisions  in  practically  all  the  great  countries 
of  Europe.  The  movement  has  been  made  the  subject  of 
national  legislation  in  France,  Switzerland,  Holland,  Great 
Britain,  Denmark,  and  Bavaria.  It  is  national  in  scope,  with 
direct  support  by  the  municipalities  in  Germany,  Italy, 
Sweden,  Norway,  Finland,  Austria,  and  Belgium.  It  has 
been  started  in  Spain  and  Russia. 

In  America  lunches  are  commonly  provided  in  the  more 
progressive  high  schools.  There  are  eighty-nine  cities,  in 
twenty-eight  States,  where  lunches  have  been  introduced  in 
the  elementary  schools,  and  six  States  in  which  the  move- 
ment for  warm  lunches  in  rural  schools  is  under  way. 

The  Progressive  party  included  school  feeding  in  its  19 13 
platform  for  New  York  State,  and  Colonel  Roosevelt  has 
gone  on  record  as  favoring  its  incorporation  in  the  State  plat- 
forms generally.  The  Socialist  party  has  long  had  school 
feeding  as  one  of  its  immediate  demands.  The  Massachusetts 
Legislature,  early  in  1913,  passed  an  act  providing  that  school 
systems  might  use  funds  for  the  support  of  lunches,  subject 
to  a  referendum  vote  of  the  citizens.  As  the  question  is  bound 
to  come  up  for  consideration  in  many  State  legislatures,  the 
following  act  has  been  formulated  on  the  basis  of  the  best 
available  experience  to  serve  as  a  model  for  school  systems 
contemplating  such  legislation: 

AN  ACT  TO  PROTECT  AND  CONSERVE  THE  HEALTH 
OF  SCHOOL-CHILDREN  AND  PROMOTE  THEIR  EF- 
FICIENCY BY  PROVIDING  MEALS  AT  COST  IN  THE 
PUBLIC    SCHOOLS 

Section  i.  Any  board  of  education  in  a  school  district  may  pro- 
vide for  serving  lunches  and  selling  them  to  pupils  attending  the 
public  schools  at  such  prices  as  it  may  fix,  not  exceeding  the  cost  of 
purchase  and  preparation  and  service  of  the  food. 


SCHOOL  FEEDING  293 

Sec.  2.  Said  board  of  education  may  employ  a  director  of  school 
lunches  and  other  necessary  assistants,  and  fix  their  rates  of  remunera- 
tion and  draw  up  rules  regulating  the  conduct  of  the  lunches  and  the 
duties  of  the  said  employees. 

Sec.  3.  Said  board  of  education  may  appoint  for  the  proper 
supervision  of  the  school  lunches  a  school-lunch  committee  which 
shall  include  in  its  membership  the  superintendent  of  schools,  the 
chief  medical  inspector,  and  the  director  of  school  lunches  or  such 
other  persons  as  the  board  may  designate. 

Sec.  4.  The  expenses  incurred  under  the  provisions  of  this  act 
shall  be  paid  in  the  same  manner  as  are  the  ordinary  expenses  for  the 
support  of  public  schools  in  the  several  school  districts. 

Sec.  S-     This  act  shall  take  effect  immediately. 

Note. — See  the  writer's  volume  on  the  above  subject. — Ed. 


CHAPTER  XVII 

MEDICAL  SUPERVISION  AND  THE  EXCEPTIONAL 

CHILD 

Purposes  of  Health  Supervision. — The  chief  purposes  of 
a  system  of  educational  hygiene  in  the  public  schools  may 
brictly  be  set  down  as: 

First:  The  diagnosis  and  exclusion  of  cases  of  contagious 
and  parasitic  diseases,  so  that  other  children  may  be  protected 
and  those  afllicted  may  receive  prompt  treatment. 

Second:  The  recognition  of  physical  defects  in  children 
and  the  correction  of  these  defects  through  the  co-operation 
of  the  school  principal,  school  nurse,  parent,  and  family  or 
dispensary  physician. 

Third:  The  correction  of  bad  conditions  in  the  physical 
environment  of  the  child  in  school,  and  the  establishment  of 
modern  methods  of  prevention,  including  health  supervision 
of  teachers  and  janitors. 

Fourth:  The  practical  teaching  of  hygiene. 

Fifth:  The  recognition,  classification,  and  segregation  of 
cases  of  mental  deficiency. 

Sixth:  The  correlation  of  medicine  and  pedagogy  so  that 
the  greatest  good  both  physical  and  mental  may  accrue  to 
the  child. 

With  the  first  four  points  we  are  not  concerned  in  this 
chapter.  They  belong  to  the  consideration  of  health  super- 
vision in  its  general  aspects,  a  subject  which  has  been  most 
ably  and  comprehensively  dealt  with  by  the  editor  of  this 
work,  and  by  other  authorities  on  school  hygiene. 

In  considering  the  fifth  of  these  purposes  let  us  remember 
that  the  term  "mental  deficiency"  here  has  the  general  signifi- 

294 


THE    EXCEPTIONAL   CHILD  295 

cance  given  it  by  Doctor  Cornell,  and  covers  mental  back- 
wardness of  all  degrees,  from  that  of  the  child  who  is  simply 
dull  from  poor  health  or  physical  defects,  or  retarded  from  ir- 
regular attendance,  late  entrance,  ignorance  of  Enghsh,  ^r 
bad  environment,  down  to  the  mental  state  of  the  child  who 
is  feeble-minded  in  the  technical  sense. 

Under  the  sixth  heading  we  must  interpret  the  correla- 
tion of  medicine  and  pedagogy  as  meaning  that  school  efficiency 
is  to  be  increased  and  pedagogy  lifted  to  the  level  of  a  real 
science  by  bringing  to  bear  upon  educational  procedures  all 
that  medicine  has  to  offer  in  its  broad  sense  of  biology,  eu- 
genics, sociology,  psychiatry,  and  psychology. 

With  the  above  scope  indicated  it  must  appear  that  the 
supervisor  of  hygiene  in  any  given  school  system  will  find  a 
definite  phase  of  his  work  interlocking  with  a  variety  of 
social  and  child-helping  agencies.  If  his  cultural  training  has 
been  broad,  he  must  early  appreciate  the  fact  that  his  work 
is  by  no  means  confined  to  investigations  of  nose  and  throat 
conditions  in  a  few  thousand  children  or  to  surveys  of  the 
physical  conditions  under  which  these  children  spend  so  large 
a  measure  of  their  waking  hours,  however  important  these 
efforts  for  improved  health  conditions  may  be.  A  very  im- 
portant phase  of  his  work  has  to  do  with  the  problems  that 
fall  under  the  head  to  which  Doctor  Rapeer  has  directed  spe- 
cial attention,  namely,  the  hygiene  of  methods  of  teaching  and 
management.  The  supervisor  of  hygiene  in  this  field  becomes 
the  medico-educationist.  It  is  here  that  pedagogy  and  medi- 
cine in  its  broad  sense  join  hands  for  the  welfare  of  the  child. 

The  Exceptional  Child.  Terminology.  Classification. — 
The  term  "exceptional"  was  at  first  used  to  designate  th~ 
unusually  able  or  brilliant  child.  Now  we  speak  of  this  type 
of  child  as  "gifted,"  and  the  term  "exceptional"  has  lost 
definition  and  has  become  a  general  heading  under  which  are 
grouped  a  variety  of  classes  and  subclasses,  composed  of 
children  bearing  almost  any  defect  or  suffering  from  almost 
any  disease  or  environmental  handicap  that  unfits  them  for 


296  EDUCATIONAL  HYGIENE 

routine  school  work  under  conditions  provided  for  the  aver- 
age, normal  pupil. 

In  a  1912  Bulletin  of  the  United  States  Bureau  of  Educa- 
tion on  "Provision  for  Exceptional  Children  in  Public  Schools," 
prepared  by  Superintendent  J.  H.  Van  Sickle,  of  Springfield, 
.Mass..  Doctor  Lightner  Witmer,  of  the  University  of  Penn- 
sylvania, and  Doctor  Leonard  P.  Ayres,  of  the  Russell  Sage 
Foundation,  we  find  a  tentative  or  temporary  grouping  of  ex- 
ceptional children,  a  grouping  which  these  investigators  stated 
at  the  time  of  the  study  they  would  not  feel  under  obligation 
to  defend  at  a  later  date,  but  which  they  felt  might  help  in 
clarif}ing  the  thought  of  those  professionally  interested  in 
exceptional  children.  The  increased  knowledge  of  the  social 
and  eugenic  aspects  of  feeble-mindedness  since  the  publica- 
tion of  this  bulletin  indicates  the  modifications  that  these  in- 
vestigators foresaw  and  alluded  to.  The  classification,  how- 
ever, focusses  attention  upon  the  scope  of  the  problem  and 
directs  the  attention  of  educational  executives  to  the  various 
types  that  must  be  considered. 

I.  Institutional  cases.  (To  be  dismissed  from  the  over- 
sight and  care  of  the  public-school  authorities.) 

1.  Morally  insane  children. 

2.  Violently  insane  children. 

3.  Demented  children. 

4.  All  feeble-minded  children  below  the  grade  of  middle-grade 
imbecile  (Barr's  classification). 

5.  High-grade  moral  imbeciles. 

6.  Severe  cases  of  epilepsy. 

^  7.  Cases  of  contagious  and  infectious  diseases  (some  to  be  dis- 
missed temporarily,  some  for  prolonged  periods). 

8.  Children  helplessly  crippled  or  suffering  from  revolting  phys- 
ical deformity. 

II.  Children  for  special  classes  or  special  instruction  in 
the  public  schools. 

1.  Foreign. 

2.  Late  entering. 

3.  Backward  but  capable  of  rapid  restoration  to  normal  grade. 


THE    EXCEPTIONAL    CHILD  297 

4.  Dull  and  feebly  gifted. 

5.  Children  requiring  vocational  training. 

6.  Children  of  precocious  physical  development,  especially  of 
precocious  sex  development. 

7.  Exceptionally  gifted  or  able  children. 

8.  Children  suffering  from  various  physical  defects  of  minor  char- 
acter but  interfering  with  their  progress  and  unfitting  them  tempora- 
rily or  permanently  for  the  grades. 

9.  Speech  cases. 

10.  Social  cases;  those  whose  retardation  is  chiefly  due  to  home 
conditions  calling  for  the  services  of  a  social  visitor  as  well  as  a  special 
teacher. 

III.  Children  of  uncertain  classification.  Institutional  or 
special  cases. 

1.  Blind  and  semiblind. 

2.  Deaf  and  semideaf. 

3.  Delinquents,  including  persistent  truants. 

4.  High-grade  imbeciles  (Barr's  classification). 

5.  All  feeble-minded  children  of  higher  grade  than  high-grade  im- 
beciles. 

6.  Crippled  children. 

7.  Children  suffering  from  epilepsy  in  mild  degree  or  from  nervous 
or  other  diseases  rendering  them  difiicult  or  improper  members  of  or- 
dinary classes. 

Doctor  Hill's  Classification. — As  a  more  restricted  group- 
ing the  following,  by  Doctor  Hill,  of  the  Department  of  Edu- 
cational Research  of  the  city  of  New  Orleans,  is  of  interest:' 

Class  A.  Feeble-minded  or  insane  children  who  should  be  under 
institutional  or  home  care  rather  than  in  the  public  schools. 

Class  B.  Backward  children  (not  in  Class  A)  or  those  who  ur- 
gently need  special  educational  methods  in  special  classes  within  the 
public  schools. 

Class  C.  Exceptionally  able  or  gifted  children. 

Class  D.  Incorrigible,  habitually  vicious  children  (i)  who  seem  to 
be  of  defective  mentality;  (2)  who  seem  to  be  of  normal  mentahty. 

Class  E.  Children  of  apparently  good  intelligence,  but  suffering 
obviously  from  some  serious  physical  defect,  temporarily  or  perma- 
nently unfitting  them  for  the  work  of  the  grades:  (i)  defective  vision; 

1  See  also  Sandiford's  classification  given  in  his  "  Mental  and  Physical 
Nature  of  School-Children"  (Longmans). 


2(^8  EDUCATIONAL   HYGIENE 

(;)  deaf  and  semideaf;  (3)  suffering  from  speech  defects;  (4)  crippled 
children;  (5)  epileptics. 

Meeting  the  Problem. — Inasmuch  as  the  practical  result 
that  we  desire  to  see  follow  child  classification  is  provision 
for  the  treatment  and  training  of  the  various  classes,  let  us 
inquire  as  to  which  class  is  most  urgently  claiming  our  at- 
tention. 

Some  half-dozen  cities  have  established  special  classes  for 
exceptionally  "gifted"  children;  a  few  cities  have  provision 
for  the  milder  epileptics  and  for  cripples;  special  provision 
has  been  made  in  a  relatively  small  number  of  systems  for 
proper  training  of  children  suffering  from  defects  of  speech; 
but  by  far  the  greatest  effort  has  been  toward  providing 
facilities  for  the  special  training  of  truants,  incorrigibles, 
backward  and  feeble-minded  children  in  the  ungraded  and 
special  classes  of  many  cities.  More  vigorous  pioneer  work 
has  been  done  along  this  line  during  the  past  few  years  than 
that  directed  toward  any  other  type  of  exceptional  child. 
It  is  true  that  not  all  epileptic,  insane,  or  other  psychic  cases 
need  be  considered  in  reference  to  their  intelligence,  yet  ep- 
ilepsy, insanity,  and  feeble-mindedness  constitute  the  inter- 
locking factors  of  one  great  problem,  and  the  first  question 
that  confronts  the  supervisor  of  hygiene  in  reference  to  the 
majority  of  exceptional  children,  be  they  truant,  incorrigible, 
"slow  to  learn,"  "stubborn,"  "foolish,"  vicious,  or  otherwise 
peculiar,  is:  what  is  the  child's  intelligence? 

Emphasizing  the  question  of  intelligence,  and  classifying 
school-children  according  to  mentality,  we  find  them  falling 
into  the  following  groups: 


I.    Supernormal  or  gifted. 
II.    Normal. 


III.   Subnormal  or  mentally 
deficient 


Backward. 

Backward-delinquent. 
Borderline.  [  Moron. 

Feeble-minded  i   Imbecile. 
[  Idiot, 


THE    EXCEPTIONAL   CHILD  299 

The  Curve  of  Normal  Distribution. — In  any  typical  school 
system  about  2  per  cent  of  the  children  will,  according  to  our 
best  standards  of  measurement,  be  found  to  be  feeble-minded. 
Idiotic  children  are  seldom  found  in  school,  although  after 
the  opening  of  special  classes  the  most  frequent  petitioners 
are  parents  who  beg  to  enter  idiotic  or  low-grade  imbecile 
children  that  have  hitherto  been  kept  at  home.  These  cases 
are  naturally  the  ones  that  lead  parents  to  grasp  at  some 
agent  of  help,  since  the  condition  here  strikes  even  the  parent 
as  unusual,  whereas  the  higher  grades  of  imbecility  and  mo- 
ronity may  be  fully  appreciated  only  by  a  trained  or  expe- 
rienced observer. 

Ranking  above  these  feeble-minded  children  comes  a  group 
roughly  designated  as  "backward,"  and  which  for  practical 
school  purposes  includes  the  borderline  cases  (until  such  are 
definitely  diagnosed  as  feeble-minded);  the  so-called  back- 
ward-delinquents, excepting  those  who  are  feeble-minded;  and 
the  mentally  sound  but  slow  children,  including  those  to  whom 
the  methods  and  curriculum  are  poorly  adapted.  This  back- 
ward squad  constitutes  from  10  per  cent  to  50  per  cent  of  the 
school  population,  perhaps  being  about  30  per  cent  in  the 
average  city. 

Above  this  group  ranks  the  great  mass  of  average,  normal 
school-children,  constituting  about  40  per  cent  to  80  per  cent 
of  the  membership  of  the  system. 

At  the  top  of  the  scale  rank  the  4  per  cent  of  children  that 
compose  the  group  of  unusually  able  or  ''gifted"  pupils. 

The  Practical  Problem. — Expert  examination  of  school- 
children shows  that  about  2  per  cent  are  of  such  mental  con- 
stitution that  they  can  never  profit  by  the  work  of  the  regular 
grades.  These  children,  scattered  through  the  regular  classes, 
are  either  neglected  or  punished  instead  of  being  studied. 
They  bring  to  us  a  part  of  the  problem  of  truancy,  in- 
corrigibiHty,  and  inability  to  learn  or  "get  along,"  and  are 
a  tremendous  drain  upon  the  energies  of  the  regular  grade 
teacher.     This  type  of  child  cannot  be  managed  like  other 


■j^QQ  EDUCATIONAL  HYGIENE 

children,  and  he  therefore  requires  special  care  and  treatment 
under  conditions  suited  to  his  abilities.  A  somewhat  larger 
number  of  pupils,  classed  as  backward,  would  profit  greatly 
by  having  special  class  opportunities.  Not  only  are  the 
regular  classes  thus  relieved  from  the  bad  example  and  drag 
e.xerted  by  these  backward  and  feeble-minded  children,  but 
by  the  school's  acceptance  of  its  duty  many  of  these  children 
will  be  saved  from  a  life  of  crime,  trouble,  and  failure,  and  will 
be  made  happy  and  useful  to  the  extent  of  their  powers. 

The  State  of  New  Jersey  requires  by  law  that  special 
classes  be  established  in  every  district  where  there  are  at 
least  ten  backward  children.  The  educational  authorities  of 
many  cities  are  alive  to  the  great  need  of  the  proper  segrega- 
tion and  training  of  these  cases,  not  only  for  their  own  welfare 
but  for  that  of  the  normal  pupils  and  of  society  at  large. 
The  training  of  such  children  is  a  specialty  in  education, 
based  upon  a  special  psychology  plus  expert  classification  and 
studv  from  a  medico-psychological  standpoint.  To  be  able 
successfully  to  conduct  a  class  of  such  children,  with  the  least 
waste  of  time  and  energy,  the  teacher  must  have  special  apti- 
tude and  training.  There  is  an  opportunity  in  such  work 
for  a  teacher  to  broaden  her  knowledge  of  child  nature  and 
to  live  close  to  one  of  the  most  vital  movements  in  modern 
education.  Approximately  i6  per  cent  of  children  in  Amer- 
ican cities  are  "repeaters"  (pupils  who  spend  more  than  one 
year  in  any  one  grade);  and  they  cost  $27,000,000  a  year  more 
to  be  passed  along  through  the  first  eight  grades  of  school  as  a 
result.  Special  classes  will  bring  about  much  saving  in  dollars 
and  cents  in  the  case  of  many  of  these  backward  children. 
But  there  will  be  another  saving,  with  the  feeble-minded  and 
bcjrderlinc  cases,  in  the  protection  to  the  community  from  the 
probleni  of  juvenile  delinquency  and  even  grave  crime. 

Consideration  of  Causative  Factors. — To  say  a  child  is 
mentally  backward  may  be  in  general  equivalent  to  saying 
that  he  has  decayed  teeth,  if  we  accept  certain  studies  that 
have  been  made  by  noted  school  hygienists;  that  he  has  en- 


THE    EXCEPTIONAL    CHILD  3OI 

larged  cryptic  tonsils  with  absorption  of  toxins  and  slow 
poisoning  of  the  system;  that  his  naso-pharynx  is  stuffed 
with  adenoid  tissue  entailing  poor  oxygenation  of  the  blood, 
nasopharyngeal  catarrh,  and  defective  hearing;  that  his  eyes 
photograph  and  transmit  to  his  brain  with  great  strain  only 
one-half  or  one-tenth  of  what  he  should  be  cognizant  of 
through  this  sense;  that  his  hearing  apparatus  collects  and 
transmits  to  his  brain  only  a  part  of  what  yours  or  mine  col- 
lects and  transmits;  that  his  digestive  and  assimilative  forces 
find  it  impossible  to  provide  fit  blood  to  nourish  brain  cells 
and  cause  them  to  function  normally  on  the  quantity  or 
quahty  of  food  furnished;  that  he  is  constantly  absorbing 
poisons  from  tuberculous  or  S3^hilitic  bones  or  glands  or  from 
a  malformed,  sluggish,  and  clogged  intestinal  tract;  that 
scarlet  fever,  measles,  rickets,  or  meningitis  has  left  a  blight 
from  infancy;  that  prolonged  delivery  or  improper  instru- 
mental delivery  at  birth  may  have  worked  injury  to  brain 
centres.  These  are  the  children  who  are  backward  because  of 
physical  defect,  disease,  or  accident.  When  the  recognition 
and  removal  of  such  defects  is  followed  by  improvement  in 
the  child's  mentality  and  when  the  child  that  previously  was 
stupid,  troublesome,  or  even  criminalistic  becomes  studious, 
obedient,  and  progressive  in  school  work,  we  may  feel  that  the 
defect  in  question  was  perhaps  the  cause  of  his  backward- 
ness. Remarkable  cases  of  this  kind  have  been  recorded. 
The  moral  is  that  such  conditions  must  be  eliminated  or  cor- 
rected in  order  that  our  subsequent  study  of  any  particular 
child's  backwardness  may  culminate  in  a  scientific  diag- 
nosis. 

Outside  of  deafness  (which  is  probably  the  most  serious 
physical  handicap  in  school  work  that  the  child  is  likely  to 
possess)  and  the  more  serious  cases  of  defective  vision  and 
poor  nutrition,  we  are  coming  to  believe  that  physical  defects 
per  se  have  less  influence  on  school  progress  than  has  been 
claimed  by  writers  in  the  popular  magazines  and  even  by 
trained  examiners  of  school-children.     The  fact  that  many 


^502  EDUCATIONAL   HYGIENE 

so-called  "environmental  cases" — backward  children  that 
are  said  to  owe  their  state  to  bad  home  conditions,  neglect, 
and  lack  of  opportunity — come  to  an  examiner  with  a  variety 
of  physical  defects,  may  have  given  color  to  such  a  belief. 
Doubtless  the  majority  of  these  cases  in  the  near  future  will 
come  to  be  seen  as  products  primarily  of  bad  heredity  and 
absence  of  prenatal  hygiene.  Upon  the  subject  of  backward- 
ness resulting  from  disease  or  physical  defect  we  find  rather  a 
wide  range  of  figures.  Figures  here  mean  little.  It  is  enough 
to  know  that  the  curve  of  normal  distribution  locates  from 
lo  per  cent  to  50  per  cent  of  school-children  in  the  backward 
squad.  Of  this  number  some  fall  under  the  class  we  have  dis- 
cussed— those  backward  by  reason  of  defect  or  disease  and 
those  who  are  victims  of  bad  home  conditions.  Others  be- 
long to  the  class  that  has  had  a  new  and  difficult  language  to 
struggle  with,  and  still  others  have  been  so  irregular  in  at- 
tendance that  little  progress  has  been  possible.  In  these 
groups  there  is  much  overlapping  and  combining  of  causes, 
and  the  exciting  and  the  contributory  causes  are  often  hard  to 
differentiate. 

A  considerable  proportion  of  the  retarded  children  that 
clog  the  machinery  of  most  city  school  systems  without  doubt 
owe  their  backwardness  to  school  curricula  and  teaching 
methods  that  are  not  in  accord  with  the  abihties  of  these 
children  that  will  usually  be  found  to  be  motor-minded. 
Proper  child  classification  should  be  the  first  step  toward  the 
correction  of  these  conditions. 

Feeble-Minded  Children. — We  must  not  forget  that  school 
work  is  not  always  a  correct  measure  of  a  child's  abihties. 
It  is  true,  however,  that  children  that  are  dull  in  the  outside 
world  as  a  rule  have  been  dull  in  school  work.  The  child 
must  be  studied  under  varying  conditions.  This  brings  us 
to  a  consideration  of  the  children  of  this  major  group  whose 
l)ackwardness  is  of  such  degree  or  such  character  that  one 
familiar  with  this  type  of  child  may  make  the  diagnosis  of 
fecble-mindedness.     To    the   untrained,    all    these    children. 


THE    EXCEPTIONAL    CHILD  303 

except  the  most  openly  peculiar,  are  referred  to  as  "back- 
ward" or  "subnormal."  As  a  standard  the  term  backward 
is  scientifically  applied  only  to  children  who,  with  certain 
physical,  educational,  racial,  or  environmental  handicaps  re- 
moved, attain  to  fairly  normal  standards  of  intelligence,  prog- 
ress, and  behavior,  and  may  eventually  become  self-support- 
ing, respectable  citizens.  The  remainder  of  these  so-called 
backward  cases  constitutes  the  group  of  children  properly 
called  feeble-minded.  Their  condition  is  incurable.  They 
are  not  able  to  do  regular  school  work  to  any  purpose  and 
they  will  never  become  useful  or  safe,  self -directing  citizens. 
The  best  treatment  for  most  of  them  in  the  pubHc  schools  at 
present  is  that  given  in  the  special  classes  for  mentally  de- 
ficient children,  where  specially  fitted  teachers  train  them, 
chiefly  along  manual  and  domestic  lines.  They  should  be 
classed  apart  from  backward  and  from  vicious  children. 
Educators  and  teachers  in  the  past  have  thought  of  truancy 
and  incorrigibility  as  things  to  be  dealt  with  as  definite  peda- 
gogical entities,  whereas  they  are  usually  but  a  couple  of 
symptoms. 

The  child's  incorrigibility  is  based  on  reasons  beyond  his 
control  under  the  usual  conditions.  The  first  step  toward 
dealing  ^vith  these  children  is  to  classify  them  and  then  train 
them  in  accordance  with  their  abilities. 

The  greatest  good  that  results  from  this  step  is  that  ac- 
cruing to  the  40  per  cent  to  80  per  cent  of  average,  normal 
children,  because  of  improved  conditions  and  methods  de- 
veloped through  a  recognition  of  the  needs  of  unusual  chil- 
dren. The  teacher,  for  instance,  of  the  backward  child  will 
almost  surely  point  the  way  to  a  newer  and  better  pedagogy 
for  teachers  of  normal  children.  The  classification  of  these 
children  is  work  for  experts,  since  some  high-grade  feeble- 
minded children  appear  to  their  teachers  and  others  far 
brighter  than  many  children  that  are  merely  backward  from 
physical  defect  or  bad  environmeat. 

The  practical  point  here  lies  in  the  fact  that  while  the 


^04  EDUCATIONAL  HYGIENE 

latter  condition  is  curable  and  the  children  harmless,  the 
feeble-mind  is  incurable,  and  these  children,  who  will  soon 
have  the  bodies  of  men  and  women  but  will  ever  remain  chil- 
dren in  intelligence,  are  a  social  responsibihty  that  an  en- 
lightened civilization  cannot  shirk.  Over  60  per  cent  of  these 
cases  of  feeble-mind  are  hereditary,  and  it  is  the  control  of 
this  tainted  stream  of  life  that  must  concern  in  considerable 
measure  the  trained  social  workers  of  the  next  thirty  years. 
The  science  of  medical  sociology  is  being  born,  and  the  social 
worker  who  directs  his  or  her  energies  along  the  lines  of  great- 
est service  will  find  a  definite  share  of  the  work  awaiting  de- 
velopment. We  should  not  stop  with  this  enumeration  of 
the  causes  of  mental  retardation  in  children.  We  must  see 
the  futility  of  a  knowledge  of  these  conditions  without  the 
response  of  time  and  money  and  service  in  an  attempt  at 
correction  and  prevention.  We  only  epitomize  this  thought 
when  we  conclude  that  in  deaUng  with  the  problem  of  the 
backward  and  feeble-minded  child,  whether  he  be  in  school, 
on  the  street,  or  before  the  juvenile  court,  the  first  step 
toward  dealing  with  him  humanely  and  practically  is  scientific 
child  classification.  With  his  status  determined  and  estab- 
lished, educational,  social,  judicial,  philanthropic,  and  public 
health  agencies  may  well  unite  in  giving  him  the  care,  protec- 
tion, and  treatment  that  are  proper  for  his  needs  and  are 
commensurate  with  his  abilities.  Thus  will  the  individual  be 
best  served  and  society  best  conserved. 

Diagnosis.^— Many  school  systems  take  no  note  of  mentally 
deficient  children  through  the  health-supervision  corps,  but 
classify  their  backward  children  on  a  basis  of  retardation  or 
pedagogical  record.  This,  of  course,  is  not  scientific.  These 
cases  demand  a  careful  consideration  under  four  main  heads: 
fi)  Medical;  (2)  Sociological;  (3)  Pedagogical;  (4)  Psycho- 
logical. 

It  seems  most  desirable  to  have  all  diagnostic  agencies 
within  the  educational  system.  The  supervisor  of  hygiene 
outside  the  larger  centres  should  be  equipped  to  handle  these 


THE    EXCEPTIONAL  CHILD. 


305 


cases  or  have  at  his  disposal  the  proper  experts.  In  every 
city  of  100,000  or  more  population  there  should  be,  as  a  fea- 
ture of  the  department  of  education,  a  medico-psychological 
laboratory  under  the  direction  of  the  supervisor  of  hygiene, 
where  an  intensive  study  may  be  made  of  all  children  that 
are  not  profiting  by  the  regular  work  of  the  grades.  A  study 
of  any  child  in  question,  to  culminate  in  a  scientific  diagnosis, 
must  place  before  the  examiner  a  careful  family  history. 
When  possible,  the  parents  should  be  seen  either  by  the  ex- 
aminer or  by  a  trained  representative.  It  is  in  this  work  that 
a  school  nurse  definitely  assigned  to  the  special  classes  can  be 
of  most  valuable  service.  She  may  be  made  responsible  for 
frequent  home  visitation  in  the  case  of  these  children;  the 
compilation  of  family  histories;  the  work  with  parents  pre- 
liminary to  the  commitment  to  institutions  as  rapidly  as 
possible  of  all  cases  that  have  been  definitely  diagnosed  as 
feeble-minded;  the  "follow-up"  system  in  connection  with 
backward  and  delinquent  children  that  leave  school  to  go  to 
work — -in  fact,  the  many  activities  along  sociological  lines 
peculiar  to  the  work  with  the  atypical  child,  if  he  is  to  be 
dealt  with  in  a  manner  best  for  himself  and  most  economical 
for  society,  may  be  hers.  A  recent  law  in  Xew  York  State 
makes  it  possible  to  commit  a  feeble-minded  child  through  any 
court  of  record  to  an  institution  without  parental  consent,  but 
the  cases  that  probably  will  be  reached  by  this  law  are  not  the 
urgent  ones,  and  proper  disposition  of  cases  of  high-grade 
feeble-mindedness  implies  an  increase  in  knowledge  of  the 
significance  and  dangers  of  moronity  which  judges  in  general 
will  probably  not  possess  for  several  years.  Returning  to  a 
consideration  of  evidence  upon  which  a  diagnosis  may  be 
based,  the  examiner  must  take  cognizance  of  anatomical  and 
physiological  variations  and  pathological  findings — the  so- 
called  stigmata.  Along  this  hne  he  will  note  the  size  and 
shape  of  the  head,  the  ears,  any  congenital  defects  indicative 
of  an  incomplete  make-up,  the  expression  of  the  face,  mus- 
cular co-ordination,  emotional  control,  presence  of  any  of  the 


3o6  EDUCATIONAL  HYGIENE 

various  paralyses,  state  of  nutrition,  condition  of  the  various 
sense  channels,  neuromuscular  tone,  and  the  character  of  the 
speech. 

The  thorough  medical  examination  should  perhaps  be  the 
first  step,  and  this  may  advantageously  include  anthropo- 
metrical  data  as  follows:  height  (standing  and  sitting),  weight, 
and  spirometer  and  dynamometer  findings,  from  which  the 
psycho-physical  curve  may  be  determined.  The  evidences 
of  defective  neuromuscular  tone  and  poor  muscular  co- 
ordination as  well  as  the  signs  of  organic  brain  disease  must 
be  sought  through  skilful  observation,  device,  and  direct  ex- 
amination. From  parents  or  family  physician  may  be 
learned  the  early  medical  history  of  the  child — prenatal 
hygiene,  accidents,  the  acute  infections  from  which  he  has 
sutTered,  antl  the  time  when  he  learned  to  walk  and  to  talk. 
From  parents  and  teachers  will  be  learned  how  he  has  behaved 
in  play,  and  the  extent  and  character  of  the  work  he  has  been 
able  successfully  to  grapple  with.  From  these  sources  will 
also  come  much  valuable  testimony  concerning  his  personal 
habits  and  his  temperamental  make-up,  and,  what  is  very 
significant,  the  record  of  his  work  in  school  under  the  con- 
ditions and  requirements  imposed  upon  hundreds  of  other 
children.  The  social  nurse  will  also  secure  data  concerning 
his  home  environment  and  the  influences,  physical  and  moral, 
to  which  he  is  subjected  outside  of  school. 

The  evidence  resulting  to  an  examiner  from  the  preceding 
investigations  under  the  headings,  medical,  educational,  and 
sociological,  will  not  always,  nor  even  frequently,  be  positive 
so  far  as  a  diagnosis  in  a  case  of  feeble-mindedness  is  con- 
cerned.   It  is  usually  only  corroborative. 

There  remains  the  most  important  line  of  procedure — 
psychological  examination.  Professor  Binet  has  neatly  em- 
[)hasized  this  by  stating  that  medical  investigation  reveals 
possible  signs  of  defect;  pedagogical  investigation  reveals 
probable  signs  of  defect;  psychological  investigation  reveals 
certain  signs  of  defect. 


THE   EXCEPTIONAL    CHILD  307 

Psychological  Examination. — This  line  of  investigaaon 
may  take  the  form  of: 

(i)  Definite  tests  of  certain  mental  processes,  as  imita- 
tion; attention;  perception  of  form,  color,  size,  number,  and 
weight;  memory;  conception;  reason  or  judgment.  These 
tests  are  of  greatest  use  in  determining  the  mental  condition 
of  a  young  child  or  a  child  of  low  mental  development.  Most 
of  the  series  of  graded  tests  for  measuring  intelligence  involve 
tests  of  the  principal  mental  processes  above  named. 

The  Form  Board. — It  has  been  stated  by  Doctor  Goddard 
that  the  form  board  gives  more  valuable  information  in  a 
shorter  time  than  any  other  piece  of  apparatus.  The  time 
and  manner  in  which  the  test  is  done,  and  the  improvement 
upon  successive  trials,  together  serve  as  an  index  of  a  child's 
trainability.  As  a  diagnostic  aid  the  form-board  record  should 
always  be  available. 

Doctor  Cornell  states  that,  as  a  fair  rule,  a  child  of  school 
age  unable  to  place  the  blocks  in  thirty  seconds  is  a  feeble- 
minded child.  This  virtually  agrees  with  the  Vineland 
Laboratory  report  on  this  piece  of  apparatus  that  we  have 
inherited  from  Seguin.  Many  valuable  and  suggestive  tests 
have  been  given  us  by  Healy,  Fernald,  Whipple,  and  Huey. 

(2)  The  direct  measuring  of  intelligence  by  a  series  of 
graded  tests. 

De  Sanctis^ s  Tests. — These  tests,  six  in  number,  formulated 
by  Professor  Sante  de  Sanctis,  of  the  University  of  Rome, 
Italy,  are  simple,  easily  applied,  and,  when  positive,  furnish 
suggestive  evidence  of  feeble  mind.  The  grading  is  not  close, 
but  with  these  tests  Professor  de  Sanctis  beheves  it  is  possible 
to  decide  that  a  child  is,  to  use  our  terminology,  a  moron, 
imbecile,  or  idiot. 

Binet-Simon  Scale. — This  graded  series  of  tests  devised 
by  Doctor  Alfred  Binet  and  Th.  Simon,  of  the  University  of 
Paris,  and  first  translated  into  EngKsh  by  Doctor  H.  H. 
Goddard,  Director  of  Research  in  the  Training  School  at  Vine- 
land,  N.  J.,  has  given  the  examiner  of  exceptional  children 


3o8  EDUCATIONAL   HYGIENE 

the  most  valuable  set  of  diagnostic  procedures  at  his  command. 
With  this  scale  an  expert  that  is  familiar  with  exceptional 
children  and  is  trained  in  psychology  may  determine  with 
great  accuracy  the  intelligence  of  a  child  in  terms  of  mental 
age.  Mental  age  in  relation  to  chronological  age  furnishes 
information  of  the  greatest  value  as  a  basis  for  classification 
of  exceptional  children,  and  is  of  vital  significance  in  the  matter 
of  pedagogical  prognosis  and  treatment.  For  details  and 
technic  of  all  the  tests  mentioned  in  this  chapter,  and  for  more 
complete  statements  of  the  chief  diagnostic  procedures  in  a 
consideration  of  exceptional  children,  the  reader  is  referred  to 
the  authorities  set  down  in  the  appended  bibliography. 
The  examination  of  these  children  by  the  supervisor  of  hy- 
giene or  his  assistants,  and  a  classification  of  them  in  reference 
to  their  trainability  or  their  need  of  permanent  custodial  care, 
will  bring  to  the  teachers  of  special  classes  a  scientific  basis 
for  their  work.  These  teachers,  if  they  have  open  minds,  are 
ready  to  accept  the  truth  about  these  children,  even  though 
it  may  upset  all  their  ideas  of  child  nature  and  child  training. 
Health  supervision  of  schools  is  a  specialty  and  con- 
stitutes far  more  than  examination  of  children  for  contagious 
disease  and  physical  defect.  The  work  of  the  supervisor  of 
educational  hygiene  during  the  next  decade  will  to  a  large 
degree  fuse  with  the  spirit  of  the  medico-educationalist,  and 
ideally  he  should  be  a  medico-psychological  expert  with  a 
s}Tnpathetic  understanding  of  the  duties  and  ideals  of  educa- 
tional executives.  If  we  could  train  a  man^  especially  for  these 
duties  in  our  public  schools  (and  we  shall  be  doing  this  every- 
where ten  years  hence),  we  would  train  him  first  as  a  school 
executive,  then  as  a  psychologist,  and  then  as  a  physician. 
He  should  have  a  good  outlook  upon  sociological  conditions 
if  he  is  io  secure  the  co-operation  of  the  various  organizations 
that  mean  so  much  in  a  comprehensive  consideration  of  the 
feeble-minded  or  delinquent  child.     With  the  above  definition 

'  Let  us  remember  that  "  man  "  is  here  used  in  the  generic  sense,  for  this  field 
invites  particularly  the  service  of  able  women. 


THE    EXCEPTIONAL   CHILD  309 

of  the  scope  of  this  special  phase  of  the  work  of  the  hygiene 
corps,  it  appears  that  a  city  should  either  employ  as  its  di- 
rector of  hygiene  a  man  so  trained,  or  engage  as  his  assistants 
the  needed  specialists — a  plan  that  has  been  adopted  with 
satisfaction  in  quite  a  number  of  our  large  cities.  Only  with 
such  a  staff  and  equipment  can  constructive  work  be  done. 

Disposition  of  Exceptional  Children. — The  following  out- 
line of  adequate  provision  for  the  treatment  and  training  of 
exceptional  children  may  seem  to  suggest  a  system  impossible 
of  attainment  in  the  near  future,  yet  nearly  all  cities  with 
systems  organized  under  superintendents  have  made  pro- 
vision for  some  type  of  exceptional  child;  a  large  number  of 
cities  have  made  a  good  start  in  the  work  with  backward  and 
feeble-minded  children;  a  considerable  number  of  systems  have 
special  provision  for  speech  cases;  for  some  years  a  number  of 
cities  have  maintained  classes  for  truants  and  disciplinary 
cases,  and  a  few  cities  have  included  in  their  educational 
policy  the  hulk  of  the  following  suggested  plan.  Other  cities 
will  press  the  matter  to  a  successful  issue.  The  larger  centres 
will  handle  the  problem  of  the  mentally  deficient  child  as 
systematically  and  effectively  as  they  have  dealt  with  the 
child  suffering  from  infectious  disease  or  physical  defect. 

With  the  adequate  training  of  physicians  entering  the  field 
of  educational  hygiene,  and  the  general  awakening  of  the  pub- 
lic to  the  needs  of  the  exceptional  child  and  the  rights  of  the 
normal  child,  the  wisdom  of  the  following  provisions  will  be 
so  apparent  that  they  will  be  recognized  as  indispensable 
features  of  a  school  system  in  any  community  that  is  per- 
forming its  duties  with  enlightened  economic  and  civic  sense. 

(i)  Medico- psychological  Laboratory.— This  should  serve  as 
a  "clearing-house"  for  exceptional  children,  and  the  super- 
visor of  educational  hygiene  and  his  staff  should  be  equipped 
for  an  intensive  study  of  these  cases. 

(2)  Special  Classes.— The  system  should  be  of  sufficient 
scope  to  offer  training  to  the  gifted,  the  backward,  the  cases 
of  speech  defect,  and  to  the  borderline  cases  until  a  definite 


3IO  EDUCATIONAL  HYGIENE 

diagnosis  of  feeble-mindedncss  has  been  made.  Adolescent 
boys  and  girls  should  be  grouped  in  separate  classes.  Some 
of  the  cases  of  speech  defect  represent  common  types  that 
are  cured  by  a  couple  of  weeks  of  simple  training,  but  a  num- 
ber of  them  are  cases  that  should  be  separated  from  normal 
children  and  should  have  the  advantage  of  a  special  teacher 
for  a  considerable  period  of  time.  The  evil  results  of  per- 
mitting these  pupils  to  continue  in  classes  with  normal  chil- 
dren He  in  the  bad  example  to  their  classmates  as  well  as  the 
pronounced  nervous  strain  upon  the  affected  pupils  and 
teachers.  In  some  of  these  cases  the  speech  defect  is  only 
one  of  a  number  of  manifestations  that  mark  them  as  degen- 
erate children.  Certain  suitable  teachers  should  be  desig- 
nated to  perfect  themselves  in  the  methods  of  training  chil- 
dren that  have  the  more  easily  cured  speech  defects,  so  that 
the  majority  of  cases  of  this  type  may  be  promptly  corrected 
and  these  children  saved  the  nervous  strain  and  retardation 
that  frequently  accompany  the  condition  when  allowed  to 
persist  for  any  considerable  time.  All  transfers  to  and  from 
special  classes  for  any  type  of  exceptional  child  should  be 
made  only  above  the  signature  of  the  supervisor  of  hygiene. 

(3)  Parental  and  Residential  Schools. — These  schools 
should  care  for  deUnquents  who  are  not  feeble-minded  or 
insane.  If  properly  conducted  they  can  supply  the  elements 
of  home  Ufe  and  the  disciphne  so  pitiably  lacking  in  the  ex- 
perience of  most  of  these  children.  The  so-called  "environ- 
mental case"  can  here  be  given  a  fair  chance  to  become  an 
honest  and  useful  citizen. 

(4)  Municipal  Farm  Colonies. — These  should  be  main- 
tained within  reasonable  distance  of  the  city,  so  that  parents 
may  visit  them  and  be  led  to  see  the  benefits  of  the  life  there 
olTcred.  In  these  colonies  should  be  placed  the  feeble-minded, 
including  all  that  are  capable  of  any  training  or  usefulness 
along  industrial  lines.  When  child-bearing  age  is  reached 
separate  colonies  will  solve  the  problem  for  those  that  are 
self-supporting,  or  nearly  so,  under  direction.     Cases  that  be- 


THE    EXCEPTIONAL   CHILD  311 

come  purely  custodial  at  any  time  should  pass  into  the  care  of 
the  State. 

Epileptics  who  are  not  feeble-minded  also  might  find  their 
brightest  haven  on  separate  farm  colonies  of  the  municipal 
type.  The  insane,  the  morally  degenerate  (who,  however,  are 
seldom  defective  in  the  moral  sense  alone),  low  grades  of  the 
feeble-minded,  and  the  feeble-minded  epileptics  should  be 
placed  as  rapidly  as  possible  in  State  institutions  for  perma- 
nent custodial  care. 

(5)  Lastly,  provision  should  be  made  in  all  city  training 
schools  for  proper  instruction  of  prospective  teachers  on  the 
health  of  school-children  and  the  hygiene  of  school  Hfe,  and 
especially  should  these  training-school  students  be  made 
familiar  with  the  exceptional  child.  There  should  also  be  pro- 
vided special  training  for  teachers  who  wish  to  become  teach- 
ers of  special  classes. 

A  system  of  health  supervision  in  the  schools  may  in  a 
few  years  banish  much  disease,  remove  many  physical  defects, 
and  work  great  reforms  in  the  hygiene  of  the  physical  child. 
Doctor  Ralph  Crowley,  a  national  school-hygiene  supervisor 
of  England,  well  says  that  the  school  medical  ofi&cer  should 
be  "not  merely  a  functionary  charged  with  specific  duties" 
but  a  "pervading  influence,"  making  himself  master  of  the 
various  problems  of  child  development,  all  of  which  have 
their  roots  deep  down  in  physiological  law.  The  problems 
considered  in  this  chapter  must  be  appreciated  as  having  a 
broad  biologic  significance,  and  years  of  patient  work  he 
before  the  educational  hygienist  and  the  constructive  edu- 
cator, working  hand  in  hand  and  alive  to  the  presence  and 
needs  of  the  exceptional  child. 


II.    SCHOOL  SANITATION 

CHAPTER   XVIII 

HYGIENIC  SCHOOL  ENVIRONMENT 

An  Introductory  Survey 

The  Problem. — The  public-school  system  must  be  satisfied 
with  nothing  less  than  the  ideal,  not  only  in  methods  of  teach- 
ing and  the  results  these  methods  accomphsh  but  also  in  the 
surroundings  the  school  gives  the  pupils  while  they  are  in  its 
care.  The  pubHc  school  should  be  a  leader  not  only  in  the 
matters  of  mere  learning  but  also  in  giving  lessons,  by  ex- 
ample, on  how  to  live  with  the  end  in  view  of  securing  the 
j:)roper  sanitary  surroundings  in  the  homes  and  business  world. 
The  public  of  every  school  community  has  a  right  to  demand 
that  only  the  best  principles  and  the  highest  ideals  should 
emanate  from  the  school,  with  respect  to  cultivating  the  mind, 
methods  of  living,  and  habits  of  life.  Childhood  is  the  im- 
pressionable time.  What  is  woven  into  the  mind  and  heart 
and  nervous  system  in  youth  is  likely  to  persist  to  the  end. 
If  a  child  grows  up  in  unclean  surroundings,  his  life  will  proba- 
bly show  throughout  something  of  the  influences  of  his  youth. 
Insufficient  clothing,  bad  food,  poor  light,  foul  air — all  these 
cast  their  blight  over  children.  Some  one  has  said  that  the 
race  advances  on  the  feet  of  little  children.  If  the  children  of 
our  present  day  can  have  better  conditions  under  which  to  de- 
velop than  did  the  children  of  the  generation  just  past,  then 
the  race  has  made  a  distinct  advance.  If  better  habits  can 
be  developed  in  children  that  now  attend  our  schools,  then 
the  race  has  so  far  gained  over  what  it  received  from  the 
schocjls  of  the  })ast. 

312 


HYGIENIC    SCHOOL   ENVIRONMENT  313 

The  responsibility  of  those  who  administer  our  schools  is 
a  tremendous  one ;  the  call  to  higher  and  better  things  is  an 
insistent  one.  What  any  new  day  may  bring  forth  can  be, 
of  course,  only  problematical,  but  all  things  point  to  that 
better  time  when  every  child  in  our  schools  will  not  only  be 
well  taught  but  will  have  about  him  every  life-giving  and 
healthful  condition:  when  he  will  have  God-given  fresh  air 
to  breathe  and  not  the  baked  air  that  devitalizes;  when  he 
will  have  pure  water  to  drink  and  not  the  germ-laden  fluid 
from  well  and  stream  and  pool  that  often  carries  disease  and 
death;  when  the  great  and  beautiful  light  of  God's  out-of- 
doors  will  have  unhindered  access  to  every  schoolroom  in 
place  of  the  half-lights  and  shades  that  dim  the  eye  and  worry 
the  nervous  system ;  when  every  child  shall  have  playground 
space  enough  to  exercise  all  his  body  powers;  when  every 
teacher  and  school  administrator  shall  know  accurately  what 
school  conditions  ought  to  be,  and  shall  leave  no  stone  un- 
turned until  those  conditions  are  obtained;  when  the  world 
shall  demand  that  every  school  be  a  perfect  place  for  children 
and  that  there  they  may  attain  to  the  fullest  development  of 
their  mental  and  physical  powers.  This  problem  of  better 
sanitary  conditions  in  our  schools  is  one  that  must  be  soon 
solved.  We  are  at  the  dawn  of  a  better  day  as  to  the  care  of 
our  children,  and  there  can  be  no  work  that  is  more  important. 

Some  Sanitary  Conditions. — This  problem  of  getting  the 
best  sanitary  conditions  in  and  about  the  schoolroom  is  not 
merely  a  school  problem;  it  is  quite  clearly  a  community 
problem  as  well.  The  school  will  not  for  any  considerable 
length  of  time  be  very  much  better  or  very  much  worse  than 
the  people  want  it  to  be,  either  as  to  the  physical  condition  of 
the  building  or  the  quality  of  the  teaching  that  is  done  in  the 
building.  These  statements  are  especially  applicable  to  the 
l/nited  States,  where  every  enterprise  rests  directly  or  in- 
directly on  public  opinion,  public  sentim.ent,  and  the  will  of 
the  people.  Any  nation-wide  survey  of  American  schools 
will  lead  to  the  conclusion  that  there  are  thousands  and  thou- 


,14 


EDUCATIONAL  HYGIENE 


sands  of  school  communities  that  need  to  wake  up  and  then 
to  catch  up  with  the  best  thought  of  the  time  on  how  to  take 
care  of  the  children  that  must  attend  the  schools.  The  re- 
sponsibility for  bad  conditions  is  seen  to  be  especially  heavy 
when  it  is  realized  that  in  most  of  the  States  there  are  com- 
pulsory-education laws  and  that  children  must  be  submit- 
ted to  the  conditions  of  the  schoolroom,  be  those  conditions 
good  or  bad.  In  a  multitude  of  communities  children  are 
forced  into  schools  where  poor  light,  air  that  is  continually 
foul,  and  contaminated  water  endanger  the  health  and  sow 
the  seeds  of  disease  and  death.  It  is  a  hard  thing  to  be  com- 
pelled to  say,  but  there  are  many  communities  where  the  school 
surroundings  are  so  bad  that  the  children  would  be  far  better 
of!  out  of  school  than  in.  Practically  every  school  survey 
reveals  this  fact.  There  is  a  tremendous  need  of  the  gospel 
of  school  hygiene.  Every  person  that  preaches  it  is  indeed  a 
missionary.  This  gospel  needs  to  go  into  many  dark  places, 
for  there  are  hundreds  of  schools  in  which  those  in  authority 
violate  every  known  law  of  the  proper  housing  and  physical 
care  of  children. 

There  are  schools  that  are  on  low,  small,  and  poorly  drained 
sites.  Especially  is  this  true  in  many  country  districts  where 
the  schools  were  placed  on  land  that  was  not  good  for  any- 
thing else  in  particular.  There  are  numerous  schools  whose 
architecture  is  that  of  a  barn,  whose  ventilation  is  unscien- 
tific, inefficient,  and  continually  harmful,  and  whose  lighting 
systems  had  no  further  planning  than  the  leaving  of  a  few 
square  holes  in  the  walls  and  filHng  them  with  windows. 
It  is  hard  to  refrain  from  making  seemingly  hysterical  and 
overcolorcd  statements  when  one  discusses  actual  conditions 
in  a  multitude  of  American  schoolrooms.  There  are  rooms 
into  which  the  light  is  admitted  from  all  four  directions, 
others  into  which  the  light  comes  from  three  directions,  and 
an  uncounted  number  that  receive  light  from  two  opposite 
sides. 

The  unjacketed  stove  of  our  fathers  is  still  doing  duty  in 


HYGIENIC    SCHOOL   ENVIRONMENT  315 

schoolrooms  everywhere,  and  many  an  urchin  is  being  baked 
on  one  side  and  chilled  on  the  other  while  he  seeks  to  follow 
the  devious  ways  of  knowledge.  Even  in  many  instances 
where  more  elaborate  systems  of  heating  have  been  installed, 
the  most  deplorable  results  are  obtained.  Foul  air-ducts  do 
not  do  their  work  properly,  rooms  are  overheated,  and  the 
air  is  baked  till  it  becomes  dryer  than  the  atmosphere  in  the 


ONE  ROOM  TOWNSHIP         CENTRALIZED  &  CONSOLIDATED 

■  RATIO  LESS  THAN  1:8  [BAD]  g   BETWEEN  RATIOS  1:8  AND  1:5  [POOR] 

□   RATIO  1;5AND  OVER  [PERMISSiBLE] 

RATIO  OF  WINDOW  SPACE  TO  FLOOR  SPACE  IN  OHIO  RURAL  SCHOOLS 
From  Ohio  School  Survey 

most  arid  regions  of  the  earth.  Colds,  coughs,  and  kindred 
troubles  come,  children  are  carried  off  by  death,  and  the 
ignorant  school  community  sighs  and  wonders  at  the  ways  of 
a  mysterious  Providence  that  sees  fit  to  strike  down  the 
fairest  flowers  in  this  garden  of  earth.  If  such  communities 
would  abandon  attributing  to  Providence  the  results  of  their 
own  ignorance  and  laziness,  and  arouse  themselves  from  their 
lethargy  and  indifference,  their  children  would  have  a  better 
chance  to  live  out  the  lives  that  Providence  has  offered  them. 
Pure  Drinking  Water. — Along  with  the  matters  of  ven- 
tilating, lighting,  and  heating  comes  the  question  of  obtain- 
ing a  proper  supply  of  drinking  water.  The  best  way  to  pro- 
vide water  is  by  means  of  drinking-fountains,  but  sometimes 


^l6  EDUCATIONAL  HYGIENE 

the  water  so  provided  is  of  poor  quality  because  of  the  loca- 
tion of  the  school  or  the  community  in  which  the  school  is 
located.  The  best  that  can  be  done  is  the  thing  to  do,  of 
course,  but  there  is  little  or  no  excuse  for  the  criminal  negli- 
gence and  ignorance  that  prevail  in  some  schools.  In  all 
too  many  cases,  in  rural  communities,  water  is  carried  from 
neighboring  farms  and  is  allowed  to  stand  all  day  exposed 
to  the  foul  air  and  the  dust  of  the  schoolroom.  No  more  is 
brought  till  the  supply  in  the  bucket  is  exhausted,  or  till  it 
gets  so  bad  or  so  warm  that  it  is  necessary  to  go  for  more. 
In  some  cases  the  water-supply  is  obtained  from  springs  or 
shallow  wells  that  catch  the  drainage  and  possible  contamina- 
tion from  the  surrounding  ground.  Where  such  conditions 
prevail  the  cause  is  usually  found  in  the  fact  that  those  re- 
sponsible are  either  too  ignorant  or  too  niggardly  to  provide 
the  proper  kind  of  a  well  on  the  school  premises.  There  is 
nothing  in  the  world  so  sacred  as  the  taxpayer's  dollar,  not 
even  the  lives  of  little  children,  in  the  view  of  many  men  who 
administer  the  financial  ends  of  school  organizations.  Every 
human  being  must  have  plenty  of  pure,  fresh  water  every 
day  if  he  is  to  keep  in  health.  The  State  has  undertaken  to 
gather  children  together  in  groups  and  to  educate  them.  The 
State  commits  a  crime  when  it  does  not  safeguard  the  health 
and  lives  of  these  little  ones  on  whom  the  future  depends. 
The  foolish,  the  careless,  the  ignorant,  and  the  indifferent 
ought  never  to  be  intrusted  with  the  care  of  the  children  in 
our  schools. 

Many  additional  details  might  be  giv^n  to  show  that  many 
conditions  in  our  schools  the  country  over  are  far  from  satis- 
factory from  a  hygienic  standpoint.  It  is  .safe  to  say  that 
very  few  school-buildings  even  approximate  ideal  conditions. 
The  surface  has  barely  been  touched  in  what  has  been  written 
above.  There  are  many  schoolrooms  that  are  looked  after 
by  teachers  and  janitors  who  have  never  even  heard  of  some 
of  the  modern  appliances  for  the  proper  care  of  school  build- 
ings.    For  the  sake  of  reminding  the  reader  in  regard  to  the 


HYGIENIC   SCHOOL  ENVIRONMENT  317 

conditions,  methods,  and  appliances  that  ought  to  be  in  use  in 
every  ideally  equipped  and  managed  school,  a  list  of  subheads 
given  by  the  editor  of  this  volume  under  the  general  topic  of 
"School  Sanitation"  is  submitted  herewith:  sites,  archi- 
tecture, ventilation,  lighting,  heating,  drinking-water,  drink- 
ing-fountains,  cleaning  and  vacuum  cleaners,  school  baths, 
hygienic  toilet  facilities,  seats  and  desks,  decoration,  fire-proof 
construction,  rest  and  emergency  rooms,  play-rooms  and  roof 
playgrounds,  open-window  rooms,  supervision  of  janitors, 
hygienic  cloak-rooms,  drying  and  warming  seats,  investiga- 
tions of  recirculation,  humidity,  air-cleaning,  disinfection,  etc. 
This  is  rather  a  formidable  list,  is  it  not?  One  can  readily 
surmise  that  to  understand  and  to  apply  the  things  suggested 
takes  something  more  than  the  mere  qualification  of  being 
elected  to  a  school  office  or  of  being  able  to  pass  a  teacher's 
examination  in  the  three  R's  with  accessories.  The  proper 
hygienic  administration  of  a  modern  school  is  a  big  problem. 
The  general  schoolroom  conditions  that  prevail  in  this  country 
are  far  from  satisfactory — every  survey  shows  that.  The  State 
cannot  fairly  and  honestly  force  children  to  attend  school  and 
then  not  properly  care  for  their  health.  There  is  splendid 
public-health  work  ahead  for  the  schoolmaster  and  the  school- 
mistress of  the  present  time. 

Sanitary  Surveys.— The  enthusiastic  inquirer  into  what 
ought  to  be  done  under  the  circumstances  can  be  given  plenty 
of  things  to  do.  The  first  thing  that  ought  to  be  on  the  pro- 
gramme of  school  betterment  from  a  sanitary  standpoint,  in 
every  State,  is  the  matter  of  a  proper  sanitary  survey.  If 
every  schoolhouse  in  the  nation  could  be  visited  by  one  or 
more  experts  and  its  physical  surroundings  made  note  of, 
if  all  the  data  in  regard  to  every  schoolhouse  could  be  set 
down  on  standard  forms  in  use  by  all  other  experts  so  that 
there  could  be  no  confusion  in  regard  to  the  results  of  indi- 
vidual surveys,  then  a  big  start  would  be  made  toward  getting 
better  conditions.  If,  for  instance,  it  could  be  known  for  any 
given  school  year  Just  how  many  schoolhouses  in  this  coun- 


3i8  EDUCATIONAL  HYGIENE 

try  arc  improperly  heated,  lighted,  and  ventilated,  how  many 
have  poor  water-supplies,  how  many  owe  their  poor  condition 
to  backward  and  ignorant  school  communities,  etc.,  every 
thinking  person  would  derive  a  tremendous  inspiration  and 
help  in  this  fight  for  better  things.  There  is  no  stimulant  like 
scientifically  determined  standards  and  exact  knowledge. 
A  thorough  national  survey  of  our  schools  would  let  all  the 
world  know  just  what  are  the  conditions  in  every  individual 
school.  With  the  knowledge  of  poor  conditions  in  any  given 
school  district  would  come  ridicule,  then  shame,  then  deter- 
mination to  have  better  things.  Community  pride  would  be 
appealed  to,  and  straightway  the  children  in  that  community 
would  have  a  better  chance  to  enjoy  life  and  health  and, 
withal,  to  get  a  better  education  because  of  better,  healthier 
bodies  with  which  to  get  that  education.  It  will  probably 
be  many  years  before  there  will  be  a  general,  simultaneous, 
national  school  survey,  but  it  ought  nevertheless  to  be  made. 
There  is  no  reason  why  the  more  progressive  States,  like  Ohio, 
cannot  take  up  this  work.^  The  results  would  be  invaluable 
not  only  in  a  direct  way  to  the  schools  themselves  but  to  the 
State  at  large  in  the  way  of  educating  the  people.  There 
is  an  almost  immeasurable  opportunity  here  for  some  State 
to  take  the  lead  in  this  direction. 

Occasionally  a  school  survey  is  undertaken  by  sending  out 
blanks  for  teachers  or  others  to  fill  out.  This  method  is 
good  so  far  as  it  goes,  but  it  has  many  faults.  With  the  pres- 
ent attitude  of  the  public  toward  such  movements,  how- 
ever, it  is  about  the  only  method  that  is  attainable  at  this 
time.  Those  who  administer  public  funds  have  not  yet 
come  to  the  place  where  they  will  permit  a  body  of  experts 
sufikient  remuneration  for  travelling  about  over  the  country 
and  finding  out  things  that  only  experts  can  find  out.  Even 
if  every  questionnaire  blank  sent  out  in  any  given  survey  were 
answered  in  full,  much  of  the  information  obtained  thereby 
would   be  inaccurate  and  unreliable.     How  many  teachers 

'  Sec  rcccnl  survc3-  rqjorts  for  Ohio,  Pennsylvania,  and  Illinois- 


HYGIENIC   SCHOOL  ENVIRONMENT  319 

or  school  officers,  even  with  stated  standards,  are  proper 
judges  of  ventilation,  lighting,  heating,  the  quality  of  drink-' 
ing  water,  the  proper  colors  to  put  on  the  walls  and  ceilings 
of  schoolrooms,  hygienic  cloak-rooms,  humidity,  disinfection, 
and  kindred  topics  that  have  to  do  with  the  proper  care 
of  children?  Even  where,  for  instance,  the  ratio  of  window 
space  to  floor  space  is  the  correct  one  and  the  teacher  knows 
that  ratio  or  standard  to  be  correct,  there  may  actually  be 
an  insufficient  amount  of  light  coming  into  the  schoolroom. 
Neighboring  trees  or  buildings  or  other  obstructions  may  shut 
out  light.  These  interfering  and  compKcating  features  may 
easily  be  lost  sight  of  by  the  inexpert.  A  report  may  show  that 
a  building  is  thoroughly  equipped  with  a  plenum  system  of 
heating  and  ventilating  and  yet  some  part  of  that  system  may 
be  working  in  a  manner  that  is  far  from  satisfactory.  Drink- 
ing water  may  be  obtained  from  a  source  that  ordinarily 
would  be  safe  enough,  and  kept  in  sanitary  drinking- fountain 
tanks,  and  yet  that  water  may  be  daily  endangering  the  lives 
of  those  who  drink  it.  The  questionnaire  method,  while  it  is 
the  best  that  can  be  used  under  most  circumstances,  has, 
then,  its  apparent  dangers  of  misinformation  and  unreliabil- 
ity. The  best  method  is  to  send  the  expert  in  person  to  in- 
spect and  report.  A  mass  of  information  gathered  in  this 
way  will  then  form  a  reliable  basis  on  which  to  base  con- 
clusions. 

The  average  school  executive,  however,  will  ask  what  he 
can  or  ought  to  do  under  the  existing  circumstances,  and  not 
what  he  might  do  with  plenty  of  money  and  an  abundance 
of  expert  assistance.  The  first  thing  for  any  school  execu- 
tive to  do,  no  matter  whether  he  be  superintendent,  princi- 
pal, teacher,  or  other  person  in  authority,  is  to  begin  with 
what  he  has  in  hand  in  the  way  of  equipment.  He  can 
first  inform  himself  as  to  needed  standards  and  requirements, 
and  then  by  investigation  and  experiment  find  out  whether 
the  pupils  under  his  care  are  working  and  living  under  satis- 
factory conditions.     He  can  measure  the  window  space  in 


^jO  EDUCATIONAL  HYGIENE 

each  room  and  lind  out  whether,  according  to  the  best  stand- 
ards, sufficient  light  is  being  admitted.  He  can  measure  the 
cubic  contents  of  each  room  and  ascertain  whether  each  pupil 
has  enough  air  space.  He  can  measure  the  air  currents  that 
enter  and  leave  each  room  in  a  plenum  system  and  find  out 
whether  each  pupil  is  receiving  enough  air  per  minute.  He  can 
test  the  drinking  water  or  send  it  to  a  State  chemist  or  other 
chemists  for  investigation.  He  can  cultivate  his  judgment 
by  the  use  of  his  common  sense  and  scientific  standards  as 
to  whether  the  colors  on  the  schoolroom  walls  are  what  they 
ought  to  be.  By  experiment  and  standard  instruments  he 
can  determine  whether  the  humidity  of  his  schoolrooms  is 
what  it  should  be.  He  can  inspect  closely  the  work  of  janitors 
and  see  whether  they  get  reasonably  satisfactory  results. 
He  can,  after  a  little  reading  and  other  investigation,  deter- 
mine whether  a  thorough,  workable,  and  constantly  used 
system  of  disinfection  should  be  installed.  In  short,  after 
some  study  of  his  sanitary  situation,  he  can  give  a  tolerably 
accurate  account  of  it  and  what  it  needs.  This  kind  of  a 
sanitary  survey  is  likely  to  bring  the  best  results  because  of 
its  having  been  done  by  the  person  who,  more  than  any  one 
else,  is  responsible  for  it  and  for  its  being  remedied.  Ex- 
pert sanitary  surveys  made  at  large  have  the  advantage  of 
being  well  done,  but  the  survey  made  by  the  person  that  must 
remedy  conditions  found  to  be  bad  is  ordinarily  of  the  most 
use.  because  it  is  more  likely  to  result  in  efficient  and  forcible 
action.  The  school  official  who  is  anxious  to  make  a  sanitary 
survey  and  to  get  health  results  therefrom  need  not  lack  for 
information  as  to  what  to  do.  The  health  officers  of  his  com- 
munity and  the  constantly  growing  body  of  literature  on  the 
subject  of  public-school  health  will  thoroughly  inform  him,  if 
he  is  anxious  to  be  informed.  One  of  the  greatest  services 
that  any  school  oflicial  can  perform  for  his  community  is  to 
make  or  have  made  a  complete  sanitary  survey  of  the  school 
l)r()j)erty  under  his  care.^ 

'  For  ciiics,  the  sanitary  inspection  forms  used  by  the  Philadelphia  schools 
will  prove  suggestive. 


HYGIENIC   SCHOOL  ENVIRONIVIENT  32I 

The  Health  Officer  and  the  School.— The  local  health 
officer,  following  the  rounds  of  his  ordinary  duties  in  looking 
after  the  public  health,  can  do  no  greater  service  than  that  of 
constantly  agitating  the  matter  of  better  sanitary  conditions 
in  the  schools.  Agitation  ought  to  be  the  first  thing  on  his  pro- 
gramme, and  then  he  ought  to  see  to  it  that  all  the  teachers 
and  school  officers  who  come  under  his  jurisdiction  are  thor- 
oughly informed  as  to  reasonable  sanitary  standards  and  know 
just  what  to  do  under  all  ordinary  circumstances.  School  of- 
ficials may  want  to  have  sanitary  matters  just  right  and  yet 
may  not  know  just  how  to  obtain  their  ends.  Energetic  and 
well-informed  health  officers  can  step  in  at  this  juncture  and  be 
of  inestimable  service  to  the  schools.  Such  officers  can  furnish 
definite  and  clear  rules  for  the  construction  and  sanitary  main- 
tenance of  schoolhouses.  They  can  interpret  and  apply 
school-health  legislation.  Through  the  legal  powers  given 
them  they  can  usually  close  up  schoolrooms  that  are  en- 
dangering the  health  of  children  and  that  will  never  be  im- 
proved except  through  some  such  vigorous  compulsion. 
Especially  can  State  boards  of  health,  when  given  enough 
support  by  law,  serve  their  States  in  a  great  and  vigorous 
way.  This  is  markedly  true  in  cases  where  the  executive 
officers  of  such  boards  are  men  of  unusual  vigor,  enthusiasm, 
and  devotion  to  the  cause  in  which  they  are  enlisted. 

The  particular  thing  that  any  health  officer  or  board  can  do, 
with  the  assurance  of  rendering  an  immediate  service,  is  the  dis- 
semination of  information  as  to  sanitary  matters,  in  language 
that  is  clear,  definite,  and  untechnical.  Further  than  this,  if 
such  information,  when  scientific,  can  be  enacted  into  law  or  if 
the  decisions  of  health  boards  can  have  the  weight  of  law,  the 
communities  affected  will  have  a  still  greater  service  rendered 
them.  Perhaps  one  of  the  most  striking  instances  of  a  State 
board  of  health  that  is  serving  the  schools  of  its  State  in 
this  definite  way  is  furnished  by  the  health  board  of  a  middle- 
Western  State  (Indiana).  Legal  enactments  and  judicial 
decisions  have  given  to  the  actions  of  this  board  the  weight 


322  EDUCATIONAL  HYGIENE 

of  law.  This  board  has  a  great  advantage  in  this  direction. 
It  demands  right  conditions.  School  people  throughout  the 
State  must  obey  its  behests.  The  problem  before  the  board, 
then,  is  extremely  simple — put  into  clear  and  direct  language  a 
set  of  rules,  based  on  the  best  modern  standards,  to  govern  the 
construction  and  care  of  all  school-buildings.  Since  these  rules 
have  the  weight  of  law,  they  must  be  obeyed.  Such  a  set  of 
rules  has  in  this  State  recently  been  formulated.  These 
rules  cover  everything  from  the  minimum  number  of  square 
feet  per  pupil  on  the  playground  to  the  reheating  of  air  under 
certain  conditions.  Any  intelligent  person  can  understand 
these  rules.  They  operate  for  all.  The  first  and  the  per- 
manent effect  has  been  the  lifting  of  sanitary  operations  in 
all  schools  to  a  much  higher  level.  Fortunate  is  the  school 
system  of  any  State  that  can  have  such  uniform  and  thorough 
administration  as  to  health  matters.  Where  they  are  under 
the  supervision  of  the  State  boards,  and  where  these  State 
boards  have  definite  and  clear-headed  poHcies  as  to  what 
ought  to  be  done,  the  local  boards  of  health  can,  of  course, 
attack  their  problems  with  more  vigor.  And  where  there  are 
in  the  State  department  of  education  efficient  departments 
of  hygiene,  the  same  results  or  better  can  be  obtained. 

Sites. — All  school  sites  should  be  easy  of  approach,  some- 
what elevated,  and  thoroughly  drained.  Water  should  never 
stand  on  a  school  yard.  A  schoolhouse  should  not  be  near 
any  condition  or  situation  that  might  impair  the  work  or 
the  health  of  the  children.  No  school  should  be  near  any 
industry  that  pollutes  the  atmosphere,  or  near  any  stagnant 
water  or  other  objectionable  situation.  Every  school  should 
have  a  playground  of  not  less  than  one  acre.  Especially  is 
this  true  in  the  country,  where  land  is  comparatively  cheap. 
In  addition  to  the  playground,  there  should  be  room  for 
school  gardening,  and  for  other  activities  that  have  to  do  with 
health  and  the  implanting  of  correct  ideals  as  to  what  beauti- 
ful school  grounds  ought  to  be.  Where  there  is  a  consoli- 
dated school,  ten  to  twenty  acres  for  a  school  farm  should  be 


HYGIENIC   SCHOOL   ENVIRONMENT 


323 


added.  The  playground  part  of  the  school  site  should  con- 
tain an  area  of  not  less  than  thirty  square  feet  for  each  pupil. 
The  grounds  should  really  be  much  larger  than  this  standard. 
In  the  opinion  of  the  writer,  healthful  out-of-doors  play  is  far 


"PuBL/e    HlQMWAy 


Cbu/tnz  Y  5C/fO0L  fARM 
icole 


(From  Dresslar's  "Rural  Schoolhouses  and  Grounds." 


Courtesy  U.  S.  Bureau  of  Education.) 

to  be  preferred  to  any  and  all  systems  of  calisthenics  in  school 
or  other  rooms.  The  child  that  has  the  room  to  run  and 
play  as  he  desires  has  a  big  help  in  the  matter  of  having  good 
health.  If  his  playground  is  well  drained  and  gravelled, 
free  from  depressions  in  which  water  can  stand,  and  equipped 


324  EDUCATIONAL  HYGIENE 

with  enough  apparatus  to  afford  proper  exercise  for  him,  he 
is  fortunate  indeed;  for  his  school  will  probably  be  more 
attractive  to  him  and  his  tendency  to  be  out  of,  or  late  in  ar- 
riving at,  school  will  be  reduced  to  a  minimum.  One  of  the 
greatest  assets  in  maintaining  the  health  of  any  set  of  school- 
children is  to  have  a  school  site  that  is  big,  healthful,  and 
serviceable  enough  to  make  it  possible  for  children  to  get  the 
most  out  of  life.  "  Excessive  housing  "  has  been  called  one  of 
the  dangers  of  modern  civilization.  It  is  the  duty  of  the  school 
to  combat  this  tendency  by  having  school  grounds  big  enough 
to  serve  to  the  fullest  the  needs  of  all  the  children.^ 

Standards  of  Construction. — The  construction  of  school 
buildings  is  an  extensive  topic.  It  includes  all  the  details  of 
planning  and  arrangement,  the  specification  of  materials, 
and  construction  according  to  the  latest  and  most  approved 
ideas  as  to  sanitation.  However,  some  general  rules  can  be 
laid  down  that  should  apply  to  the  construction  of  almost 
every  schoolhouse.  Local  conditions  may  possibly  produce 
variations  from  these  standard  rules,  but  in  the  main  they 
probably  should  prevail.  The  first  of  these  suggestions  is 
that  no  school  building  should  be  more  than  two  stories  in 
height,  above  the  basement.  The  objection  will  at  once  be 
made  that  in  cities,  where  the  price  of  real  estate  is  largely 
beyond  the  reach  of  school  funds  and  where  the  number  of 
children  to  be  taken  care  of  is  large,  it  is  absolutely  necessary 
to  build  schoolhouses  more  than  two  stories  in  height.  The 
necessity  may  in  certain  atypical  cases  seem  to  exist,  but  there 
are  some  people  who  claim  that  the  health  and  lives  of  chil- 
dren are  more  precious  than  real  estate,  and  that  every  school 
should  have  room  enough  in  which  to  take  care  of  every 
child  in  the  way  it  ought  to  be  taken  care  of.  Children  more 
than  two  stories  from  the  ground,  with  the  best  of  modern 
fireproofing  of  buildings,  are  running  serious  dangers  from  fire, 
and  they  probably  undergo  undue  strain  in  constantly  chmb- 
ing  two  or  more  flights  of  stairs.    The  second  general  rule  in 

» See  Chapter  XXIV. 


HYGIENIC   SCHOOL  ENVIRONMENT  325 

construction  is  that  all  school-buildings  shall  be  constructed 
so  as  to  be  absolutely  fire-proof  or  as  nearly  so  as  is  possible. 
All  exits  should  be  as  wide  as  possible,  and  all  interior  wood 
finish  should  be  as  small  in  amount  as  possible.  Further- 
more, all  wood  finish  and  all  plastering  should  be  so  constructed 
as  to  minimize  or  prevent  the  collection  of  dust.  Every 
window-sash  ought  to  contain  as  few  panes  of  glass  as  possible, 
and  where  it  seems  difficult  to  light  rooms  properly  prism 
glass  should  be  used.  Especial  attention  should  be  paid  to 
the  matter  of  fighting,  for  mistakes  in  this  direction  are  often 
not  easily  detected  and  may  produce  much  harm. 

Heating  and  ventilating  systems  should  take  fresh  air  from 
outside  the  building,  diflfuse  it  throughout  each  schoolroom, 
and  carry  out  the  foul  air  at  a  rate  of  not  less  than  eighteen 
hundred  cubic  feet  per  hour  for  each  two  hundred  and  twenty- 
five  cubic  feet  of  schoolroom  space,  in  all  conditions  of  the 
outside  atmosphere.  Even  where  stoves  are  used,  apparatus 
should  be  installed  to  take  air  from  outside  the  school - 
house  and  to  conduct  to  the  outside  the  foul  air.  The  health 
authorities  in  any  community  should  prevent  the  use  of  a 
school-building  that  does  not  approximate  in  fresh-air  ef- 
ficiency the  standard  set  out  above.  Automatic  tempera- 
ture regulation  should  be  provided  in  all  buildings  with  cen- 
tral heating  systems.  No  matter  how  faithful  the  teacher  or 
the  janitor  may  be  in  looking  after  the  heating  and  ventila- 
tion, he  cannot  be  as  efficient  as  the  best  modern  regulating 
apparatus.  The  very  fact  that  a  teacher  is  in  and  inured  to 
the  schoolroom  often  disquafifies  him  for  quickly  and  ac- 
curately judging  whether  the  room  is  too  warm  or  too  cold, 
and  whether  fresh  air  is  needed.  The  usual  temperature 
formerly  recommended  for  the  schoolroom  was  seventy  de- 
grees, and  the  ordinary  regulation  apparatus  is  set  for  that 
figure,  but  children  may  have  as  good  or  better  health  at  a 
lower  temperature,  especially  if  there  is  a  proper  degree  of 
humidity  in  the  schoolroom.  The  usual  heating  apparatus 
should  provide  easily  a  temperature  ranging  from  sixty-six  to 


326  EDUCATIONAL  HYGIENE 

sixty-eight  degrees.  In  summary,  the  proper  amounts  of  heat, 
light,  and  fresh  air  are  the  first  things  to  be  taken  into  con- 
sideration in  the  erection  of  any  building. 

Another  feature  that  must  be  looked  after  carefully  is 
the  proper  installation  of  toilet  and  wash-room  facihties. 
Cleaning  the  building  should  also  be  made  as  easy  as  possible. 
Vacuum  sweepers  and  every  other  modern  appliance  ought 
to  be  put  in  the  trained  hands  of  the  janitors.  Wherever 
possible,  inclines  should  be  substituted  for  stairways,  since 
inclines  permit  each  person  ascending  them  to  take  such 
steps  as  suit  him;  there  is  consequently  less  physical  strain; 
and  the  inclines  are  in  many  ways  more  serviceable  than  the 
stairs.  All  dry  dusting  and  sweeping  must  in  every  school 
be  strictly  prohibited.  In  fact,  the  one  thought  of  every 
architect,  builder,  and  administrator  of  every  school-build- 
ing ought  to  be  that  the  children  are  to  be  looked  after  first, 
last,  and  always.  Their  health  and  their  general  welfare  are 
to  be  considered  at  all  times,  and  everything  that  is  done 
should  point  principally  toward  that  end.  No  building  is  ever 
erected  merely  for  the  purpose  of  giving  any  teacher,  janitor, 
or  other  person  a  position  on  the  public  pay-roll.  And,  al- 
though these  persons  should  also  be  given  the  best  possible 
hygienic  conditions,  ''Service  to  Cliildren  "  should  be  the  motto 
whenever  and  wherever  a  public  school  is  built  and  maintained. 

The  Janitor. — There  is  one  very  important  factor  in  the 
care  of  every  schoolhouse  and  that  is  the  character  of  the 
work  of  the  janitor.  It  is  useless  to  talk  of  school  hygiene  and 
to  construct  sanitary  buildings  unless  these  buildings  are 
to  be  cared  for  in  the  correct  way.  The  importance  of  the 
janitor's  work  is  often  underestimated,  and  that  person  him- 
self is  all  too  often  not  given  a  fair  chance  either  to  know 
what  to  do  or  to  have  the  tools  with  which  to  do  his  work  as 
it  should  be  done.  Some  one  has  suggested  that  since  it  is 
thought  necessary  in  these  days  of  classes  in  domestic  economy 
to  train  homekeepers  who  have  charge  of  the  health  of  in- 
dividual families,  it  might  also  be  well  to  train  the  men  and 


HYGIENIC   SCHOOL  ENVIRONMENT  327 

women  who  take  care  of  school-buildings,  many  of  which 
contain  hundreds  of  people  where  the  home  usually  contains 
but  a  few  individuals.  The  fact  of  the  matter  is  that  most 
campaigns  for  better  sanitary  school  conditions  begin  at  the 
wrong  place.  The  first  thing  to  do,  in  many  instances,  is 
to  see  that  the  man,  woman,  or  boy  who  daily  cleans  the 
schoolroom  and  cares  for  the  rest  of  the  schoolhouse  under- 
stands his  problem,  knows  why  it  is  harmful  to  do  dry  sweep- 
ing, appreciates  the  necessity  for  having  plenty  of  fresh  air 
coming  into  the  room  all  the  time,  and  reaHzes  in  a  general 
way  how  important  his  work  is.  Further,  teachers,  prin- 
cipals, and  superintendent  ought  to  understand  the  work  of 
the  janitor.  In  many  cases,  if  there  were  a  fuller  understand- 
ing there  would  be  more  sympathy  and,  consequently,  better 
work.  Further,  school  officials  should  see  to  it  that  the  janitor 
has  all  the  necessary  appliances  and  arrangements  with  which 
to  do  his  work.  If  school  health  is  the  first  consideration, 
then  the  means  of  securing  and  maintaining  that  health 
should  always  be  at  hand.  Cutting  down  on  the  amount  of 
the  janitor's  supplies  is  a  poor  way  to  economize  if  any  ef- 
fectual sanitary  work  is  to  be  done.  He  should  have  all  the 
appliances  that  are  necessary  for  him  to  do  his  work  well. 

All  are  agreed  that  it  is  best  to  have  all  persons  who  care 
for  the  child's  mental  development  take  courses  of  instruc- 
tion and  pass  certain  examinations.  Why  would  it  not  be 
well  to  require  courses  of  instruction  and  examinations  for 
the  persons  who  are  to  have  a  very  important  part  in  caring 
for  the  children's  physical  welfare?  Will  it  be  possible  to 
secure  the  best  results  in  school  sanitation  before  some  such 
instruction  and  tests  are  required  of  all  janitors?  In  all 
too  many  cases  the  janitor  owes  his  position  to  the  fact  that 
he  belongs  to  some  political  faction  or  that  he  has  some  in- 
fluence other  than  fitness  for  the  work  he  is  appointed  to  do. 
No  other  consideration  than  ability  and  faithfulness  should 
enter  into  the  process  of  employing  and  retaining  a  janitor. 

Further,  a  good  work  can  be  done  by  any  school  execu- 


328  EDUCATIONAL  HYGIENE 

tive  if  he  will  get  his  janitors  together  occasionally  and  dis- 
cuss with  them  the  various  matters  that  have  to  do  with  the 
proper  care  of  school  buildings.  For  instance,  the  subject  of 
the  proper  lighting  of  schoolrooms  could  be  explained  at  a 
meeting  of  the  janitorial  force.  Discussions,  illustrations,  and 
experiments  could  be  utilized  in  an  effort  to  get  all  to  under- 
stand the  great  importance  and  standard  requirements  of 
the  subject.  Other  meetings  could  be  called  for  the  consider- 
ation of  other  problems.  A  feeHng  of  sympathy  between  the 
janitors  and  the  school  authorities  could  thus  be  created 
that  would  not  otherwise  exist.  The  whole  situation  would 
be  materially  improved  in  any  school  system  where  such  a 
well-planned  scheme  of  bettering  sanitary  conditions  through 
the  janitor  is  undertaken.  The  janitor's  work  is  of  the 
greatest  importance.  He  cannot  know  too  much  about  his 
work  and  there  cannot  be  too  great  an  understanding  of  and 
sympathy  with  the  magnitude  of  his  tasks  and  the  difificulties 
that  they  present. 

A  General  View. — In  a  broad  survey  of  school  conditions 
in  this  country  there  is  to  be  found  much  that  is  hopeful  in 
general  as  well  as  in  the  particular  phases  that  have  to  do 
with  school  sanitation.  Progress  in  any  one  school  line  must 
eventually  mean  progress  in  all  other  lines.  Generally  speak- 
ing, the  most  modern  methods  of  teaching  are  found  in  the 
most  modern  buildings.  The  community  that  wants  good 
teaching  generally  wants  good  school-buildings  and  will  get 
them  if  possible.  In  sanitary  as  well  as  other  matters  the 
dream  of  to-day  will  be  the  actuality  of  to-morrow,  and  we 
shall  constantly  move  on  to  better  things. 

Conclusions. — This  introductory  survey  of  sanitary  con- 
ditions in  the  schools  throughout  the  country  leads  to  certain 
general  conclusions  of  a  practical  nature,  namely: 

Practically  everywhere  in  our  country  there  is  the  spirit 
of  progress  in  matters  of  school  sanitation. 

There  is  to-day  a  very  much  greater  expenditure  for  sani- 
tary measures  and  appliances  than  ever  before. 


HYGIENIC    SCHOOL    ENVIRONMENT  329 

City  schools  spend  proportionately  more  along  sanitary 
lines  than  do  country  schools. 

As  a  rule,  city  school-buildings  excel  in  matters  of  heat- 
ing, lighting,  and  ventilation,  as  well  as  in  several  other  im- 
portant features.  There  are  many  exceptions  to  this  rule,  but 
it  nevertheless  prevails. 

Every  school  should  have  plenty  of  light;  plenty  of  good, 
pure,  unbaked,  Hfe-giving  air;  good  water;  bathing  facihties; 
roomy  playgrounds;  in  many  instances  school-prepared  noon 
lunches;  and  all  other  things  that  go  to  the  making  and  main- 
taining of  health. 

Whenever  our  people  get  ready  to  spend  as  much  money 
on  public  education  and  health  as  on  their  hogs  and  cattle, 
and  on  some  of  the  unnecessary  and  harmful  things  in  which 
they  indulge,  there  will  readily  come  to  pass  all  the  things  of 
which  we  dream. 

The  schoolhouse  should  be  the  model  for  the  community 
in  all  sanitary  matters.  It  should  be  the  centre  of  a  radiating 
gospel  of  good  health. 

Finally,  the  one  great  opportunity  to  lay  the  foundations 
of  a  superior  public  health  is  to  be  found  in  the  public  schools. 


CHAPTER   XIX 
SCHOOL  SANITATION  STANDARDS 

A  Sanitary  School  Environment. — The  problem  of  furnish- 
ing children  of  a  community  with  a  thoroughly  hygienic  and 
sanitary  environment  can  be  seen,  in  the  light  of  past  chapters, 
to  be  one  of  great  difificulty  as  well  as  one  of  supreme  impor- 
tance. Sanitary  home  and  neighborhood  conditions  are  only 
a  part  of  the  problem.  When  we  come  to  the  school  main- 
tained by  the  State  with  compulsory  attendance  for  all  chil- 
dren up  to  a  certain  age,  we  have  the  problem  in  an  acute  form. 
The  State  is  not  only  responsible  for  the  health  of  its  involun- 
tary charges,  but  it  is  extremely  interested  in  their  hygienic 
welfare.  It  is,  moreover,  bound  to  set  as  high  an  ideal  of 
sanitation  as  possible  as  an  example  to  the  public,  which  has  a 
right  to  take  it  as  a  standard.  The  most  sanitary  home  in  the 
country  is  not  too  high  a  standard  for  the  State  public  school.* 

Moreover,  the  problem  offers  many  new  difficulties  non- 
existent in  the  ordinary  home.  The  average  family  is  from 
four  to  six  in  number,  while  the  average  detached  house  or 
apartment  has  about  the  same  number  of  rooms,  an  average 
of  about  one  to  a  person.  At  the  school,  the  average  is  about 
thirty  to  forty  persons  to  a  room,  instead  of  but  one  to  a  room. 
Moreover,  these  persons  are  from  many  different  homes  and 
sources  of  possible  contagion.  In  the  home,  free  movement 
about  the  house  is  possible;  at  the  school,  each  pupil  leads,  for 
the  most  part,  a  sedentary  life  in  a  seat  usually  screwed  to  a 
fixed  spot  in  the  room.  These  and  many  other  considerations 
have  led  to  innumerable  grievous  sanitary  errors  on  the  part 
of  school  directors,  carpenters,  and  janitors.  Their  "apper- 
ceptive basis"  has  been  that  of  home  conditions,  and  this 

'See  Professor  Irvinj^  King's  recent  bulletin  on  "Hygienic  Conditions  in 
Iowa  Schools,"  published  May  29,  191 5,  by  the  University  of  Iowa,  Iowa  City, 
Iowa. 

330 


SCHOOL   SANITATION    STANDARDS  33 1 

has  been  mechanically  transferred  to  the  construction  and 
sanitation  of  schools. 

Much  if  not  most  of  the  recent  interest  and  development 
in  the  field  of  educational  hygiene  has  been  along  school- 
sanitation  lines  and  a  number  of  the  recent  flood  of  books 
indicate  this  emphasis,  one  of  the  best  of  them  devoting  about 
fifteen  chapters  to  school  sanitation,  seven  to  medical  inspec- 
tion, two  to  the  hygiene  of  instruction,  one  to  physical  educa- 
tion, and  none  to  the  teaching  of  hygiene.  A  large  part  of 
this  interest  and  development  has  been  brought  about  by  the 
fortunate  competition  of  school  engineers,  architects,  and 
supply  houses  for  the  large  money  rewards  in  this  field.  The 
competition  of  inventive  genius  and  the  nation-wide  adver- 
tising of  sanitary  drinking-fountains  has,  for  example,  been  a 
big  factor  in  this  one  step  of  sanitary  improvement.  Other 
illustrations  are  innumerable. 

It  is  manifestly  impossible  to  treat  in  a  few  pages  or 
chapters  of  an  average  book  the  details  of  this  rapidly  develop- 
ing science  and  practise.  We  must  limit  our  discussion  to 
the  barest  fundamentals.  These  fundamentals  must  and 
should  be  of  the  nature  of  standards  or  norms  by  which  to 
test  and  to  guide  effort  in  this  field.  But  on  looking  for  such 
standards  one  must  at  once  be  struck  with  the  fact  that  we 
are  practically  without  real  scientific  standards  of  school 
sanitation.  We  have  numerous  tentative  standards,  a  lot  of 
consensus  of  opinion  and  practise,  a  great  deal  of  dogmatism 
and  imitation,  but  few  scientifically  established  standards. 
The  recent  investigations  of  ventilation,  for  example,  have 
destroyed  the  old  opinion-standards  of  the  baleful  effects  of 
carbon  dioxide  and  lack  of  oxygen  in  classrooms,  and  there  is 
a  tendency  to  deride  the  costly  and  intricate  mechanical  ven- 
tilation systems  of  the  present  and  to  rush  to  open  and  fresh- 
air  rooms  and  schools.  Any  observant  person  in  education 
knows  of  multitudes  of  expensive  school  sanitation  fads  and 
fashions  that  have  come  and  gone,  seeming  to  benefit  princi- 
pally only  the  fashioners  and  sellers  of  the  "latest  thing"  to 
unsuspecting  school  men  and  boards  of  education. 


332  EDUCATIONAL  HYGIENE 

Undoubtedly  great  good,  as  well  as  much  harm,  has  been 
done  by  the  wide-spread  adoption  of  new  opinion-standards. 
The  remarkable  progress  of  city  school  sanitation  is  due 
largely  to  this  one  factor.  The  unrivalled  advance  in  hospital 
and  office-building  architecture  and  sanitation  has  had,  too, 
its  more  scientific  influence.  But  think  of  the  cost  and  the 
injury  of  such  methods!  Millions  for  change  but  not  one 
cent  for  scientific  investigation,  has  been  our  motto.  Word 
goes  out  from  some  bureau,  book,  or  self-styled  expert  that, 
for  instance,  the  lighting  of  schools  should  be  from  the  left 
side  only,  and  schools  everywhere  gradually  adopt  this  norm. 
But  the  schools  of  the  future,  especially  small  rural  schools, 
may  some  day  be  changing  back  to  lighting  on  both  sides  of 
the  classroom,  because  scientific  study  may  show  that  the 
shadows  of  pupils'  pencils  and  hands  on  their  papers  are 
not  seriously  detrimental  if  at  all,  or  that  other  features,  such 
as  more  illumination,  or  cross  ventilation  in  hot  weather,  are 
of  greater  hygienic  importance.  We  do  not  know!  It  is 
quite  possible,  at  any  rate,  for  a  scientific  investigation  of 
school  ventilation  problems,  such  as  the  Thorndike-Winslow^ 
experimentation  now  going  on,  to  overthrow  many  cherished- 
as-absolute  standards  of  the  past,  and  to  do  a  million  times 
more  real  lasting  good  than  man}^  whole  State  surveys  which 
say:  "This  is  bad  according  to  our  (opinion)  standard 
and  your  laws  must  be  immediately  made  to  enforce  the 
change." 

Being  practically  without  very  stable  and  scientific 
standards,  then,  we  must  content  ourselves  with  cautious 
statement,  in  the  briefest  terms,  of  some  of  the  empirically 
derived  and  established  standards  now  available.  They  can 
be  found  scattered  in  many  publications  and  in  evidence 
in  many  schools  in  many  places.  We  shall  emphasize  the 
larger,  city  school  because  the  rural  school  problem  has  two 
chapters  devoted  to  it.  In  certain  cases  sanitary  standards 
will  of  course  have  to  be  sacrificed  for  large  educational  or 

'  See  "  Some  Results  of  the  First  Year's  Work  of  the  N.  Y.  State  Commis- 
sion on  Ventilation,"  American  Journal  of  Public  Health,  Feb.,  1915. 


SCHOOL   SANITATION    STANDARDS  333 

social  ends.  The  centre  of  a  neighborhood,  for  example,  may 
not  have  as  good  soil  as  other  locations  and  yet  it  may  be  best 
to  choose  it,  all  things  considered. 


Tentative  School  Sanitation  Standards 

I.  The  Site. — (i)  Speaking  generally,  as  we  must  through- 
out, the  site  should  be  on  rather  elevated,  porous,  uncon- 
taminated  soil,  preferably  gravel  and  sand.  Muddy,  wet 
feet  and  clothing,  and  foul  air  rising  through  the  basement 
from  a  contaminated  soil,  must  be  avoided. 

(2)  Size. — Ten  to  twenty  acres  of  good  land  should  be 
made  available  for  consohdated  rural  schools,  two  to  three 
acres  for  school  and  neighborhood  playgrounds.  Thirty 
square  feet  of  play  space  for  each  pupil  as  a  minimum  has  been 
made  a  standard  by  the  National  Playground  Association  of 
America.  Dresslar  is  authority  for  the  statement  that 
"according  to  the  rules  of  the  London  School  Board  100 
square  feet  of  play  space  is  required  for  each  pupil. "^  Allow- 
ance must  be  made  for  the  future  extensions  of  the  building 
and  for  any  parking  space  absolutely  required.  A  full  city 
block  is  a  convenient  minimum  standard.  Where  blocks  are 
as  small  as  200  feet  square,  two  for  each  school  will  frequently 
be  standard. 

(3)  Surroundings .^ — The  school  site  must  be  in  a  quiet 
place,  free  from  dust,  bad  odors,  and  gases,  overshadowing 
buildings,  and  away  from  sources  of  ill  health  or  injury  to 
pupils.  This  standard  rules  out  thousands  of  American 
schools,  now  located  on  street-car,  automobile,  heavy-traffic, 
and  even  steam-railway  streets  or  lines,  or  near  dusty  roads 
or  factories,  gas-houses,  livery  barns,  planing-mills,  saloons  and 
other  such  houses,  etc.  Foresight  and  the  law  must  be  used 
to  protect  schools  from  such  dangers  to  life,  nerves,  health, 
and  sanitation. 

II.  The  Building. — (i)  The  building  should  be  arranged 
longitudinally,  so  classrooms  may  have  unilateral  east  or  west 

*  Portland,  Oregon,  School  Survey,  p.  220. 


334  EDUCATIONAL  HYGIENE 

lighting,  the  children  in  the  rooms  on  the  west  side  of  the 
building  (if  of  several  rooms)  facing  north  and  those  in  rooms 
on  the  east  facing  south. 

(2)  If  possible,  the  building  should  be  placed  at  the  west 
side  of  the  school  site,  with  the  separate  heating  plant  to  the 
west  of  the  building.  This  puts  almost  the  entire  playground 
in  front  of  the  school  building,  where  it  can  be  supervised  to 
some  extent  from  the  principal's  ofhce  (when  he  cannot  get 
out),  which  should  probably  be  in  the  middle  of  the  front  on 
the  second  floor.  If  this  part  of  the  building  is  made  to  pro- 
ject somewhat,  windows  may  be  put  into  the  office  to  give 
north  and  south  views  of  the  playground  also.  The  Bernard 
Moose  School,  of  Chicago,  designed  by  Dwight  L.  Perkins,  is 
built  in  this  manner. 

(3)  The  rear  of  the  building  to  the  west,  with  its  separate 
heating  plant  and  smoke-stack,  should  be  made  as  attractive 
as  the  front  if  possible,  so  the  building  will  not  have  to  "turn 
its  back"  on  any  neighborhood. 

(4)  Practically  every  school  should  have  a  well-lighted 
concrete  basement.  In  smaller  schools  the  heating  plant 
will  be  located  here.  Great  care  should  be  taken  to  prevent 
the  upward  movement  of  moisture  in  the  walls  to  the  school 
walls  above.  Slate,  pitch,  and  other  substances  are  used  to 
cut  off  this  upward  movement. 

(5)  Arched  roofs  and  steeples  are  rapidly  giving  way  to 
flat  roofs,  and  very  low  towers  if  any,  on  the  larger  school 
l)uildings  of  four  or  more  rooms.  Roof  playgrounds  should 
be  provided  where  needed. 

(6)  Every  school  building  should  be  as  nearly  fire-proof 
as  possible,  and  the  larger  the  building  the  more  emphasis 
there  should  be  on  this  factor.  We  have  lost  too  many  build- 
ings and  children  by  fire.  An  average  of  ten  school  buildings 
burn  each  week  of  the  year,  two  each  school  day. 

(7)  The  following  helpful  suggestions  for  making  schools 
fire  and  panic  proof  are  taken  from  "Fire  Protection  in  Public 
Schools,"  distributed  by  the  Division  of  Education,  Russell 
Sage  Foundation.      See  also  the  maps  which  follow. 


States  having 
no  laws 


FIRE  PROTECTION  LEGISLATION  FOR  SCHOOLHOUSES 


No  Regulation 


LAWS  RELATING  TO  SCHOOLHOUSE  CONSTRUc  1  ION  IN  EACH  STATE 

IN  1912 

(From  "  A  Comparative  Study  of  Public  School  Systems  in  Forty-Eight  States "  by  the 
Russell  Sage  Foundation.) 


^^6  EDUCATIONAL  HYGIENE 


STAIR  AND  EXIT  RULE  OF  NEW  YORK  CITY» 

(i)  All  school  buildings  of  two  or  more  stories  in  height  shall 
have  at  least  two  stairways.  The  number  and  width  of  stairways 
shall  be  apportioned  as  follows:  Four  feet  for  the  first  50  pupils  and 
six  inches  additional  width  for  each  additional  50  pupils. 

Note. — The  number  of  stairways  shall  be  sufficient  to  permit  of 
building  being  vacated  in  orderly  manner  within  three  minutes  from 
sounding  of  signal.  Most  fires  spread  rapidly.  Any  longer  delay 
may  result  in  exits  being  cut  off. 

(2)  In  estimating  number  of  occupants  for  each  story,  an  allowance 
shall  be  made  of  fifteen  square  feet  of  floor  space  per  person  per  class- 
room. 

(3)  Stairs  shall  not  be  less  than  four  feet  nor  more  than  five  feet  in 
width  between  strings.  The  four-foot  width  for  elementary  schools 
is  preferable.  Width  is  fixed  at  four  feet  to  prevent  a  third  line  of 
pupils  without  handrail  support. 

(4)  There  shall  be  a  handrail  on  each  side. 

(5)  No  closets  shall  be  placed  under  stairs.  Where  they  exist  they 
shall  be  kept  empty  and  locked. 

(6)  All  stairs  shall  be  enclosed  in  wire-glass  and  steel  or  other  fire- 
proof partitions  from  top  to  bottom,  access  being  by  means  of  self- 
closing  fire-proof  doors.     These  doors  are  held  open  by  fusible  links. 

(7)  There  shall  be  an  allowance  made  of  fifteen  lineal  feet  width  of 
doorways  for  the  first  500,  and  six  inches  additional  width  for  each  100 
additional,  persons.  These  widths  should  be  increased  by  50  per  cent 
if  there  be  an  auditorium  on  the  first  floor,  or  basement  which  has  not 
direct  exits. 

IF  YOU  ARE  TO  HAVE  A  NEW  SCHOOL  BUILDING 

(i)  Employ  an  architect  who  knows  what  it  means  to  erect  a  fire- 
proof building  and  then 

(2)  See  that  his  plans  call  for: 

(a)  Fire-proof  construction. 

(6)  Building  of  not  more  than  three,  and  if  possible  not  more 
than  two,  stories. 

(c)  If  a  large  school,  each  floor  constructed  with  fire-proof  parti- 
tions, so  that  one  section  may  be  completely  shut  off  from  the  rest. 

(d)  Heating  plant  separated  from  rest  of  building  by  fire-proof 
walls,  ceilings,  and  doors. 

(e)  Assembly-room  on  ground  floor. 

(/)    Attic  cut  by  at  least  one  partition,  to  prevent  draughts. 

*  From  a  Sage  Foundation  pamphlet  on  fire  prevention. 


SCHOOL   SANITATION   STANDARDS  337 

(g)  Stairs  located  at  opposite  ends  of  building,  and  leading  di- 
rectly to  exits. 

(h)  Stairs  built  according  to  the  "stair  rule."     (See  above.) 

(/)    Halls  wide,  well  lighted,  and  absolutely  free  from  obstructions, 

(j)  Outer  doors  furnished  with  "panic  bolts"  which  can  be  opened 
from  inside  by  slight  pressure. 

(k)  Automatic  sprinklers  in  storeroom  and  fuel-room. 

And  then — 

(3)  See  that  the  building  is  constructed  according  to  the  specifi- 
cations. 

IF  YOU  HAVE  AN  OLD  SCHOOL  BUILDING 

(i)  Transform  stairs  into  fire-proof  exits  by  following  the  rule  given 
above.  See  that  stairs  lead  directly  to  outer  doors,  even  if  their 
location  has  to  be  changed. 

(2)  Make  basement  ceiling  fire-proof.  , 

(3)  Abolish  double  doors.  Substitute  single  doors,  swinging  out- 
ward, side  by  side,  and  equipped  with  "panic  bolts."  Absolutely 
prohibit  fastening  of  any  outside  door  during  school  hours. 

(4)  See  that  ashes,  waste  paper,  and  other  rubbish  are  placed 
separately  in  metal,  self-closing  receivers,  and  removed  from  building 
at  close  of  each  day. 

(5)  See  that  building  is  equipped  with: 

(a)  Automatic  fire-alarm. 

(b)  Complete  system  of  fire  signals. 

(c)  Signal  connection  with  fire  headquarters. 

(6)  Require  halls  to  be  kept  absolutely  free  from  lockers,  tables, 
chairs,  and  all  other  obstructions. 

(7)  Insist  on  a  fire-drill  every  two  weeks. 

(8)  The  building  must  be  as  free  from  dust-catchers  as 
possible.  All  interior  v^oodwork  should  be  without  unneces- 
sary flutes  and  grooves.  Fluted  or  beaded  ceilings  or  wain- 
scoting, and  much-decorated  washboards  and  blackboard 
frames,  are  inadmissible.  Picture  mouldings  are  recom- 
mended, but  they  should  be  devised  to  catch  little  dust. 
Dresslar  would  eliminate  them,  but  they  seem  desirable  for 
non-sanitary  reasons.  The  hospital  ideal  is  not  too  good  for 
the  schools.  Beauty  need  not  be  sacrificed  but  may  be  en- 
hanced by  thoroughly  sanitary  construction. 

(9)  Corridors  may  be  a  standard  width  of  14  feet  in  schools 


338  EDUCATIONAL  HYGIENE 

of  several  rooms.  In  the  far  West  a  new  standard  of  having 
one-story  buildings  with  classrooms  on  one  side  of  the  cor- 
ridor only  is  being  advocated,  and  seems  desirable  for  that 
climate  in  cities  that  will  provide  the  necessary  land  space. 
All  corridors  should  be  well  lighted,  should  have  cement  or 
light-colored  composition  floors,  should  be  unencumbered 
with  lockers  or  wardrobes,  and  should  be  provided  with 
satisfactory  drinking-fountains,  preferably  in  "batteries"  of 
four  or  more  over  a  narrow  trough  close  to  the  wall.  The 
latter  need  not  be  as  elaborate  and  costly  as  are  frequently 
purchased. 

(10)  All  other  flooring  should  be  sound-proofed  and  made 
of  close-grained  hardwood  or  of  rift-sawed  pine.  As  soon  as 
laid,  the  floor  should  be  given,  well  rubbed  in,  two  coats  of 
boiling  linseed-oil,  in  which  one  pound  of  parafifin  to  each 
gallon  of  oil  has  been  dissolved.  This  coating  closes  up  and 
protects  the  wood  and  provides  a  vitreous-like  surface  easily 
cleaned  and  hard  to  splinter.  ^  (See  later  standards  for  clean- 
ing.) 

III.  The  Standard  Classroom.  Elementary  Schools. — 
Standards  for  elementary  classrooms  have  been  gradually 
developed  on  the  basis  of  present  knowledge  and  theory 
until  many  of  the  features  have  been  finally  adopted  by  school 
officials  in  many  parts  of  the  country,  especially  by  State 
boards  of  education  and  progressive  school  architects.  Within 
certain  limits  there  will  remain  considerable  variation,  es- 
pecially as  our  scientific  knowledge  of  children  and  of  sanita- 
tion increases.  The  classroom  is  the  centre  of  the  school. 
Here  teacher  and  pupils  engage  for  most  of  the  time  in  that 
activity  for  which  schools  are  primarily  created.  The  san- 
itation of  the  classroom  should  therefore  be  as  perfect  as 
possible.  We  cannot  give  here  the  arguments  leading  up  to 
each  feature,  nor  a  discussion  of  reasonable  variations.  A 
statement  of  a  desirable  norm  only  is  attempted. 

1  See  the  Springfield,  111.,  Survey  for  attention  to  better  specifications  and 
better  supervision  of  construction. 


SCHOOL   SANITATION   STANDARDS  339 

(i)  Architects  must  provide  one  or  more  standard  class- 
rooms for  each  school  building.  The  standard  classroom  is 
the  unit  of  construction.  Instead  of  devising  a  building  of  a 
certain  size  and  then  putting  in  classrooms,  they  must  reverse 
the  usual  process  and  provide  the  required  number  of  standard 
classrooms  and  erect  the  building  about  them.  With  so 
many  millions  of  dollars  going  each  year  into  new  school 
buildings,  coupled  with  the  fact  that  so  many  old  schools  are 
burning  down,  it  seems  that  tliis  country  should  soon  ex- 
perimentally develop  ideal  buildings.  Scientific  study  and 
expert  school  architects  only  are  lacking  to  make  the  most 
of  our  opportunities,  but  they  are  surely,  though  slowly, 
coming. 

(2)  Size. — The  best  size  for  an  elementary  classroom 
for  about  forty  pupils  seems  to  be,  all  matters  considered: 
length  32  feet,  height  13  feet,  width  24  feet.  This  size  has 
in  consideration  suflEicient  lighting  space,  the  carrying  power 
of  voices,  distance  for  seeing  and  hearing,  ease  of  class  man- 
agement and  instruction,  ventilation,  building  economy,  etc. 
The  height  may  be  reduced  six  inches  and  the  length  a  foot 
or  more,  if  desired.  In  high  schools  the  height  should  be  the 
same,  but  the  floor  area  and  shape  must  be  variable.^ 

(3)  Lighting. — In  standard  classrooms  the  lighting,  meas- 
ured in  area  of  window-glass,  should  be  at  least  one-fifth 
to  one-fourth  of  the  area  of  the  floor  space.  The  floor  area 
(24  X  32)  is  768  square  feet.  One-fourth  of  this  is  192  square 
feet  and  one-fifth  is  153  square  feet.  This  lighting  should 
be  from  the  left  side  only  of  the  pupils  seated,  with  few  ex- 
ceptions later  to  be  mentioned.  Windows  should  reach  to 
within  five  or  six  inches  of  the  ceiling — the  higher  the  better, 
since  about  one-third  of  the  light  comes  in  at  the  upper  fourth 
of  the  windows.  The  windows,  on  the  thirteen-foot  wall, 
should  not  reach  below  a  line  three  and  one -half  feet  above  the 
floor;  should  extend  as  far  toward  the  rear  of  the  room  as 

1  See  Dresslar's  "School  Architecture,"  published  by  the  U.  S.  Bureau  of 
Education,  for  valuable  data  on  high  schools. 


34<^  EDUCATIONAL  HYGIENE 

possible  (within  eighteen  inches) ;  should  not  extend  far  enough 
forward  to  throw  much  light  into  pupils'  eyes;  and  should 
have  the  narrowest  possible  piers  or  mullions  between  the 
windows,  say  one  foot  as  a  maximum  and  these  bevelled. 
Round  or  gothic  topped  windows  should  not  be  permitted.  In 
upper  grades,  the  height  from  the  floor  may  be  four  feet.  This 
leaves  an  eight  and  one-half  or  nine-foot  window  in  length. 
The  width  of  the  glass  panes  may  well  be  about  forty-two 
inches  and  height  forty-five  inches.  Small  panes  are  generally 
less  desirable.  Starting  the  windows  with  the  glass  of  the  rear 
window  about  fifteen  or  eighteen  inches  from  the  rear  wall  and 
leaving  not  over  twelve  inches  between  windows,  glass  to 
glass,  for  mullions  and  (steel)  lintels,  with  nine-foot  windows, 
we  find  that  we  can  put  in  five  such  windows  and  get  a  glass 
surface  of  about  one  hundred  and  sixty  square  feet,  leaving 
nine  feet  of  blank  wall  at  the  front  of  the  room.  Not  less 
than  six  or  seven  feet  should  be  left  a  solid  wall  at  the  front. 
By  reducing  the  width  of  windows  three  inches  (to  thirty-nine 
inches)  six  windows  may  be  put  in,  giving  a  lighting  area  of 
about  one  hundred  and  seventy-five  square  feet.  The  latter 
is  probably  preferable  in  most  cases.  The  use  of  a  twelve  and 
one-half  foot  ceiling  is  economical  but  makes  nine-foot  win- 
dows impossible  except  in  primary  rooms  where  the  bottoms 
are  only  three  and  a  half  feet  from  the  floor. ^ 

An  increase  in  the  width  of  the  windows  to  four  feet  has 
been  tried  successfully  in  some  schools.  Such  width  helps 
to  reduce  the  number  of  mullions  between  windows  by  one, 
and  gives  a  lighting  space  of  about  one  hundred  and  eighty 
square  feet  with  five  windows.  This  is  almost  ideal,  but  re- 
quires that  the  windows  be  well  put  in  so  they  may  be  easily 
handled.     This  gives    also   a  well-lighted   blackboard,   but 

'Dresslar  recommends  this,  however,  in  his  "School  Hygiene,"  p.  6i. 
The  Sharp-Millar  photometer  is  a  good  instrument  for  measuring  actual  illu- 
mination. Standard :  three  foot-candles  at  worst-lighted  desk  on  a  cloudy  da}'. 
Dr.  Fitz  gives  a  new  method  of  determining  lighting  values  in  the  Proceedings 
of  the  Fourth  International  Congress  on  School  Hygiene. 


SCHOOL   SANITATION   STANDARDS  34I 

teachers  should  not  make  a  habit  of  standing  near  the  front, 
window  side  of  the  room,  in  order  to  keep  children  from  facing 
the  light  when  looking  at  her.  A  door  into  the  cloak-room  at 
the  front  of  the  room  on  the  lighted  side  makes  it  impossible 
to  place  a  blackboard  in  this  corner,  which  is  an  advantage 
from  this  point  of  view. 

It  is  injurious  to  the  eyes  to  face  windows,  both  for  teachers 
and  pupils;  consequently  there  should  be  no  windows  on  the 
front  wall,  and  on  the  rear  wall  only  when  it  is  thought  de- 
sirable for  ventilation.  If  the  rear  wall  is  an  outside  wall, 
small  windows  placed  high  (eight  feet  from  the  floor),  with 
their  tops  on  a  level  with  the  other  windows  and  with  stained 
or  other  glass  not  admitting  much  light,  may  be  used.  This 
gives  a  window  the  size  of  the  upper  sash  of  the  other  win- 
dows. These  half-windows  may,  however,  be  narrower,  and 
should  be  hinged  at  the  bottom  and  have  a  spring  catch  at 
the  top.  Light  from  the  rear  is  good  for  the  pupils  but  not 
for  the  teacher. 

It  is  possible  to  have  such  windows  also  on  the  right  side 
of  the  pupils  seated,  thus  giving  light  and  ventilation  into  the 
corridor.  These  may  well  swing  on  a  pivot  and  be  controlled 
by  iron  levers.  These  extra  openings  are  principally  for 
ventilation,  however,  rather  than  for  lighting.  I  have  seen 
such  "transoms"  working  admirably. 

Windows  in  rear  or  right-side  walls  need  not  be  put  in 
merely  for  the  sake  of  outside  decoration.  Architects  have  de- 
vised many  ways  of  beautifying  blank  walls  where  there  are 
no  windows. 

Artificial  Lighting. — All  classrooms  should  have  arti- 
ficial hghting  for  use  on  very  dark  days  and  especially  for 
evening  use.  If  possible,  electricity  should  always  be  used, 
and  all  buildings  should  be  well  wired  when  constructed. 
Gas-pipes  should  also  be  installed  where  gas  is  available. 
Acetylene  lighting  has  been  found  satisfactory  in  rural  schools 
where  the  other  forms  are  unavailable.  Much  attention 
should  be  given  to  the  proper  placing  of  the  various  ceiling 


342  EDUCATIONAL   HYGIENE 

lights  and  to  bringing  sufficient  light  from  the  proper  angle  to 
all  seats  in  the  room.  Where  there  are  six  rows  of  well-placed 
single  seats,  the  front  row  of  ceiling  lights,  say  three  in  number, 
may  be  placed  a  little  in  front  and  to  the  left  of  the  first  desk 
near  the  window,  the  third  desk  from  the  window,  and  the 
fifth.  The  second  row  may  be  over  the  first,  third,  and  fifth 
desks  in  the  third  cross  row  of  seats,  while  the  third  row  may 
be  placed  similarly  just  back  of  the  fifth  row.^ 

Window-Shades. — Most  window-shades  in  schools  are  ob- 
jectionable, either  because  they  are  not  translucent  and  so 
cut  off  too  much  light  when  down,  or  they  are  hard  to  manage, 
or  they  cannot  be  adjusted  to  diminish  only  the  light  which 
is  too  bright  for  the  pupils'  eyes.  The  Draper  and  other 
window-shades  can  be  easily  adjusted  to  cut  out  light  where 
desired,  and  the  plan  of  having  the  curtain  roll  at  the  bottom 
instead  of  the  top,  or  of  having  two  rolls  at  the  middle,  is 
to  be  commended.  Ecru  or  light-tan  color  has  been  highly 
recommended.  Dark  green  should  be  avoided.  Light  green 
or  light  gray  may  be  used  to  harmonize  with  wall  colors.  The 
ideal  is  to  get  plenty  of  light  without  cutting  off  too  much 
and  without  allowing  the  direct  rays  of  the  sun  to  fall  on  the 
pupils'  work. 2 

Wall  Colors. — All  walls  should  be  smooth  but  not  glossy, 
and  painted  with  washable  fiat  paint  in  light  tans,  light 
greens,  hght  buffs,  or  light  grays.  A  cement  dado  should  take 
the  place  of  the  ordinary  wooden  wainscoting,  and  may  be 
painted  a  darker  color  than  the  walls  above.  The  ceiling  may 
be  nearly  white  in  color.  Great  differences  in  light  can  be 
made  by  giving  care  to  wall  colors.  In  corridors,  more  white 
can  be  used  without  injury  to  pupils'  eyes,  and  white  tiling 
for  the  first  four  or  five  feet  above  the  floor  is  desirable. 


*See  Dresslar's  "School  Hygiene,"  p.  78. 

''Doctor  Ayres  found  in  the  Springfield,  III.,  Survey  that  the  illumination 
was  kept  below  the  standard  of  three  foot-candles  even  on  bright  days,  because 
teachers  did  not  properly  adjust  the  shades,  and  that  windows  covered  with 
dirt  and  coal-soot  cut  off  in  some  cases  50  per  cent  of  the  light. 


SCHOOL   SANITATION   STANDARDS  343 

Blackboards  absorb  much  light  but  can  easily  be  covered  by 
curtains,  matching  the  wall  color,  which  can  be  pulled  down 
when  blackboards  are  not  in  use.  Such  curtains  function 
also  in  keeping  work  that  the  teacher  puts  on  at  intermission 
from  the  children's  gaze  until  they  are  ready  to  work  on  it. 
Sliding  blackboards  have  been  invented. 

(4)  Heating. — The  standards  for  heating  one  or  two  room 
buildings  are  discussed  in  other  chapters.  The  proper  tem- 
perature for  classrooms  in  this  country  is  from  65  to  68 
degrees.  Rooms  should  be  allowed  to  go  above  70  degrees 
only  on  cold  mornings  while  the  building  is  being  heated  up. 
The  air  should  be  about  half-saturated  with  moisture,  say  55 
per  cent.  No  dogmatic  and  general  standards  can  be  made 
here  for  all  sections  of  a  great  country  like  America,  and  for 
schools  of  all  sizes  from  one  to  a  hundred  rooms.  Hot-air 
furnaces  for  small  schools  of  two  to  six  rooms  are  in  some 
cases  desirable,  especially  in  the  places  where  there  are  mild 
winters.  Hot-water  heating  has  many  advantages,  but  is 
slow,  and  not  desirable  for  the  more  northern  schools,  perhaps. 
Steam-heating  is  growing  in  favor  in  all  of  the  larger  schools. 
It  works  well  with  a  fan  (plenum  or  exhaust  or  both)  system 
of  ventilation,  l^hen  we  have  the  air  entering  the  rooms 
slightly  heated  and  the  air  heated  indirectly  by  radiators  also, 
we  have  what  is  called  the  very  common  and  desirable  "di- 
rect-indirect" method  of  heating  schools. 

(5)  Ventilation. — ^The  problem  of  furnishing  40  or  more 
children,  seated  for  hours  at  a  time  in  a  single  room  contain- 
ing less  than  10,000  cubic  feet  of  space,  with  a  sufficient 
amount  of  fresh  warm  air  without  draughts  is  one  of  the  most 
serious  problems  of  school  sanitation.  Two  movements  tend 
to  disturb  our  standards  in  this  field  at  the  present  time: 
The  open-air-school  movement  has  brought  a  great  emphasis 
on  obtaining  outdoor  conditions  without  great  discomfort, 
and  a  wide-spread  discontent  with  current  methods  of  ven- 
tilation. Secondly,  the  numerous  scientific  studies  and  ex- 
periments of  recent  years  have  fairly  well  proved  that  it  is 


344  EDUCATIONAL  HYGIENE 

not  the  lack  of  oxygen,  or  the  excess  of  carbon  dioxide  or  of 
organic  particles  that  makes  schoolroom  air  unfit  to  breathe, 
but  that  it  is  improper  temperature,  lack  of  variation  in 
temperature  and  movement  of  the  air,  and  lack  of  humidity 
that  cause  the  bad  effects.  These  two  beliefs  have  led  to  two 
principal  applications:  furnish  less  heat  and  make  classrooms 
into  fresh  or  open  air  rooms,  and,  second,  make  classrooms 
into  closed-air  rooms,  and  by  the  use  of  return  ducts  and 
careful  air- washing  and  humidifying  return  all  air  to  the  class- 
rooms, thus  making  it  recirculate  over  and  over  again. 

Not  counting  the  initial  costs  of  any  changes  in  windows 
or  the  purchase  of  bags  for  the  children  to  sit  in  in  cold 
weather  the  open-air  room  is  evidently  more  economical 
than  the  fan  system,  saving  very  much  in  the  way  of  coal. 
Likewise,  overlooking  the  cost  of  return  ducts,  air-washers, 
and  closing  up  of  cracks,  the  recirculation  of  the  air  for  given 
lengths  of  time  is  very  much  more  economical  than  the  pres- 
ent systems,  which  heat  up  a  lot  of  air  and  then  force  it  out 
almost  immediately  in  the  effort  to  get  proper  ventilation. 
Experiments  made  at  Springfield,  Massachusetts,  and  else- 
where indicate  a  saving  of  about  40  per  cent  in  fuel.  The 
air  is  cleaned,  made  moist,  and  is  used  for  a  half-day  or  so  at  a 
time  without  change.  It  is  claimed  that  the  air  is  unobjec- 
tionable by  this  method  and  that  it  is  even  better  than  the 
outside  air,  being  free  from  dust.  By  bringing  such  air  into 
the  rooms  near  the  pupils'  faces,  as  in  the  Minnesota  experi- 
ment,^ and  by  varying  the  velocity  occasionally,  coupled  with 
arrangements  by  which  rooms  are  occasionally  flushed  with 
fresh  outdoor  air,  it  seems  that  we  have  here  the  beginnings 
of  an  economical  method  quite  different  from  the  one  so  long 
employed  where  we  have  tried  to  heat  up  and  push  through 
schoolrooms  and  on  outdoors  2,000  cubic  feet  per  minute 
per  classroom.     We  must  await  further  experiments  and  tests 

•  See  address  by  Professor  Bass  in  the  Proceedings  of  the  Fourth  Interna- 
tional School  Hygiene  Congress,  also  addresses  by  McCurdy,  CJulick,  and  others. 
See  also  articles  by  Kimball  and  W'inslow  in  Science  for  April  30,  1915. 


SCHOOL   SANITATION   STANDARDS  345 

along  this  line.  Perhaps  the  open-air  method  can  in  the 
future  be  employed  in  mild  and  warm  weather  and  the  re- 
circulation device  utilized  in  cold  weather.^ 

Open- Air  Rooms. — Another  chapter  deals  with  open-air 
rooms  and  schools.  The  proper  construction  of  windows  for 
such  rooms  is  still  in  the  experimental  stage,  although  such 
bodies  as  the  Boston  Schoolhouse  Commission  and  others 
have  given  the  matter  much  study  and  have  succeeded 
fairly  well.  The  Oakland  School-Building  Inquiry  recom- 
mended that  "in  each  new  building  there  shall  be  at  least  one 
open-air  schoolroom  that  cannot  be  entirely  closed,  preferably 
opening  to  the  east.  In  all  new  buildings  there  shall  be  pro- 
vision made  whereby  every  classroom  may  be  easily  trans- 
formed into  an  open-air  room,  such  transforming  measures  not 
to  be  under  the  control  of  teachers  and  pupils." 

One  plan  that  has  seemed  to  work  has  been  that  of  making 
the  entire  window  in  one  sash  and  hinging  this  at  the  top  so 
it  can  be  pulled  inward  and  upward  by  a  strong  cord  and 
fastened.    Many  other  plans  are  being  used. 

Common  Methods  of  Ventilation.- — Three  common  methods 
of  ventilation  are  in  vogue:  window  ventilation,  gravity  ven- 
tilation, and  mechanical  ventilation.  Most  schools  of  our 
country  use  the  first  method  but  with  notoriously  poor  re- 
sults. Little  attention  is  paid  to  ventilation  in  most  homes, 
since  there  are  so  few  persons  to  a  room,  since  all  are  free  to 
move  about,  and  since  enough  air  frequently  slips  in  at  cracks 
and  through  walls  to  supply  fairly  well  the  needs  of  ventila- 
tion, although  there  is  probably  also  a  great  lack  of  proper 
ventilation  in  many  homes,  especially  in  sleeping-rooms. 
Most  schools  have  in  the  past  been  provided  \vith  as  little 
means  of  proper  ventilation  as  most  homes,  but  the  conditions 
are  entirely  different,  especially  in  the  great  number  of  per- 

'  See  chapter  on  the  "  Physiology  of  Ventilation"  in  Terman's  "The  Hygi- 
ene of  the  School  Child,"  Hill's  pamphlet  on  "The  Relation  of  the  Atmosphere 
to  Our  Health,"  published  by  the  Smithsonian  Institution,  Washington,  D.  C, 
and  Kimball's  articles  in  the  School  Board  Journal  for  1914-15. 


346  EDUCATIONAL  HYGIENE 

sons  from  different  families  that  are  here  collected  together 
to  remain  relatively  fixed  in  stationary  seats.  Teachers  are 
typically  young  women  without  a  professional  education  and 
with  little  training  or  knowledge  of  ventilation  needs  and 
devices.     They  must  study  and  be  trained  along  these  lines. 

Window  Methods. — Windows  should  be  opened  and  the 
rooms  flushed  out  with  outdoor  air  at  all  recesses  and  inter- 
missions. Further,  teachers  and  pupils  need  not  be  afraid  of 
fresh  air  in  classrooms.  By  keeping  on  more  clothing  than  in 
a  seventy-degree  atmosphere  teachers  and  pupils  can  easily 
and  quickly  accustom  themselves  to  almost  outdoor  con- 
ditions even  in  cold  weather.  They  usually  profit  by  it,  be- 
coming enthusiastic  champions  of  fresh  air.  Draughts  should 
be  avoided  when  they  strike  directly  on  pupils.  Window- 
boards  six  inches  in  width  and  the  width  of  the  window  in 
length  may  be  placed  beneath  the  window  in  such  a  way  as 
completely  to  close  up  the  space  at  the  bottom  of  the  window 
but  leave  a  space  between  the  sashes  in  the  middle  of  the  win- 
dow where  the  air  will  come  in  when  it  is  colder  outside  than 
inside,  without  a  draught  on  any  pupil.  Such  boards  are  awk- 
ward to  remove  unless  they  are  cut  into  and  hinged  in  the 
middle.  Any  boy  can  make  one  for  each  window  in  a  short 
time  or,  better  still,  a  group  of  boys  can  make  them  co-opera- 
tively. If  too  much  light  is  cut  out  by  this  method,  upward 
and  inward  slanting  glass  deflectors  may  be  used.  Dresslar  de- 
scribes three  kinds  in  his  article  on  "Ventilation"  in  Monroe's 
"Cyclopedia  of  Education,"  volume  five.  Teachers  should 
study  the  matter  even  where  they  have  gravity  systems  of 
ventilation.  Iflri  the  middle  of  a  period  the  room  gets  foul, 
the  children  may  be  given  calisthenics  or  marching,  or  may  be 
sent  to  run  around  the  house  once  or  twice,  while  the  room  is 
being  flushed.  The  teacher  must  cultivate  a  sensitive  nose  for 
bad  air  and  remember  at  all  times  that  the  tendency  is  to  get 
gradually  accustomed  to  poorer  air  as  a  period  goes  forward. 

Gravity  Systems. — Differences  in  weight  of  warm  and  cold 
air  make  possible  in  cold  weather,  when  windows  cannot  well 


The  Austral  window,  showing  method  of  venlilatinK  without  drafts 


SCHOOL   SANITATION   STANDARDS  347 

be  opened  without  draughts  and  heat-expense,  systems  known 
as  gravity  systems.  They  are  generally  not  ejSicient  enough 
for  schools  except  in  the  coldest  weather,  but  must  be  used 
in  all  small  schools  where  forced,  mechanical  draughts  are  out 
of  the  question  because  of  the  expense.  The  jacketed  stove 
has  been  described  in  the  chapter  on  "Rural  School  Sanita- 
tion" by  Mr.  Monahan.  Heat  within  the  jacket  and  heat 
in  the  chimney  about  the  aspirating  or  outlet  duct  for  foul 
air  causes  the  air  to  rise  and  spread  in  the  room  and  to  be 
forced  out  by  the  colder  air  coming  from  without  through  a 
flue  passing  under  the  floor  to  a  vent  within  the  jacket  of  the 
stove.  Care  must  be  taken  to  insure  that  the  fresh  air  brought 
in  is  not  that  from  under  the  building  and  that  the  opening 
to  the  outside  is  covered  with  a  screen. 

The  hot-air  furnace  is  another  gravity  system.  The  fur- 
nace is  usually  placed  beneath  the  floor  in  the  basement  and 
has  a  flue  bringing  in  outside  air  and  other  flues  or  pipes 
taking  the  air  up  to  the  room  or  rooms.  The  fresh  air  coming 
from  the  furnace  should  enter  the  room  on  an  inside  wall  if 
possible  and  about  eight  feet  from  the  floor.  All  persons 
putting  in  such  devices  should  get  expert  advice  from  either 
the  State  department  of  education  located  in  the  capital  city 
or  from  the  United  States  Bureau  of  Education  at  Washing- 
ton. This  applies  to  most  sanitary  features,  especially  to  the 
plans  and  construction  of  the  school  itself,  and  is  about  the 
most  valuable  recommendation  of  this  entire  chapter.  Get 
expert  advice  and  save  for  years  to  come  not  only  the  money 
of  the  community  but  its  comfort  and  health. 

Mechanical  Systems  of  Ventilation. — This  plan  does  not 
depend  upon  gravity  alone  but  puts  a  fan  into  the  system  to 
force  the  air  into  the  rooms,  the  plenum  system;  and  fre- 
quently adds  to  this  in  large  buildings  another  fan  near  the 
top  of  the  building  to  blow  the  air  out,  the  vacuum  or  exhaust 
system.  Where  the  upper  fan  is  omitted,  a  feature  of  the 
gravity  system  is  sometimes  added  in  the  form  of  small  steam 
coils  in  the  foul-air  flues  to  heat  the  outgoing  air  and  make  it 


348  EDUCATIONAL  HYGIENE 

rise  faster.  Generally  the  plenum  fan  or  blower  in  the  base- 
ment is  sufficient. 

Accepted  standards  for  such  ventilation  require  at  least 
thirty  cubic  feet  of  air  for  each  person  in  the  room  per  minute. 
The  air  should  enter  the  room  at  a  height  of  eight  feet  above 
the  floor  through  a  vent  about  two  feet  square.  If  a  grating 
is  placed  over  this  inlet  it  should  be  of  such  small  cross-bars 
as  not  seriously  to  retard  the  air.  It  should  also  have  de- 
flectors attached  to  throw  the  air  upward  and  toward  all 
parts  of  the  room.  The  speed  of  the  entering  air  should 
not  be  more  than  400  feet  a  minute  as  measured  by  the 
anemometer  (a  small  fan  wheel  connected  with  a  clock-like 
recording  arrangement  to  measure  velocity).  The  ducts  to 
each  room  of  forty  pupils  should  be  at  least  four  feet  square 
in  cross-section,  so  as  to  keep  the  velocity  within  them  down 
below  600  feet  a  minute.  The  entrance  duct  may  be  at  the 
front  of  the  room  and  the  outlet  duct  (four  square  feet  in  area) 
at  the  floor  in  the  same  wall,  with  another  outlet  six  to  eight 
feet  above  the  floor  in  the  cloak-room  behind  the  front  wall  of 
the  classroom.  The  air  can  be  made  to  reach  the  cloak-room 
by  placing  openings  in  the  bottom  of  the  doors  leading  from 
the  classroom  to  the  cloak-room.  Such  an  arrangement 
helps  to  dry  and  aerify  the  clothing.  Long  hooks  far  enough 
apart  should  be  used  to  keep  the.  clothing  from  contact,  and 
open  for  drying  and  aeration.  This  cloak-room  should  be 
about  six  feet  in  width  and  should  have  no  door  leading  into 
the  corridor.  A  large  window  should  light  it  well,  and  drip- 
troughs  for  umbrellas  and  pigeonholes  for  overshoes  should 
be  provided. 

The  fan  or  blower  in  the  basement  should  be  noiseless  and 
should  be  large  enough  to  provide  an  ounce  of  pressure  without 
running  more  than  three  hundred  revolutions  per  minute.^ 
The  fresh  air  should  be  taken  from  a  point  where  there  is  little 
dust  or  smoke,  which  in  cities  is  usually  high  in  the  air  above 
the  roof.    If  the  air  is  still  dusty  or  smoky  it  should  be  washed 

'  Professor  Caswell  Ellis  in  the  School  Board  Journal  for  September,  1913. 


SCHOOL   SANITATION   STANDARDS  349 

before  entering  the  rooms.  Numerous  devices  for  air-wash- 
ing have  been  devised,  about  the  best  at  present  providing 
for  passing  the  air  through  a  stream  or  "rain"  of  water 
dropping  from  small  holes  in  a  pipe  across  the  passage.  Pro- 
fessor Whipple,  of  Harvard,  has  made  a  number  of  very  valu- 
able experiments  in  this  field.  Such  an  arrangement  if  properly- 
put  in  may  provide  sufficient  humidity  to  the  warmed  air  also. 
The  standard  for  humidity  is  about  55  per  cent  saturation.^ 
Steam  pans,  as  in  the  Horace  Mann  School,  Columbia  Uni- 
versity, work  very  well  as  humidifiers  if  large  and  well  regu- 
lated by  automatic  devices  controlling  both  temperature  and 
amount  of  moisture,  but  do  not  clean  the  air  appreciably.  A 
great  fault  with  most  such  systems  is  that  janitors  persist- 
ently overheat  ("cook")  the  air.  It  is  doubtful  if  the  air 
should  ever  be  hotter  than  65  degrees  Fahrenheit  in  the  fan- 
room  of  the  basement,  and  very  little  warmer  when  it  enters 
the  rooms.  The  radiators  principally  should  be  depended  on 
for  heat.  The  air  should  be  kept  as  cool  as  possible  consistent 
with  comfort.  Provision  should  be  made  whereby  the  air  may 
be  shunted  at  times  into  the  ducts  without  passing  through 
the  heat  coils  across  the  entrance  to  the  fan-room,  thus  mak- 
ing it  possible  to  get  fresh  .outdoor  air  at  physical  training 
or  other  periods.  In  the  writer's  own  experiments  a  hinged 
screen  was  thrown  in  front  of  the  coils  and  a  door  at  the  side 
opened  into  the  fan-room  to  let  the  fresh  air  directly  into  the 
fan. 

The  air  velocity  of  all  rooms  should  be  measured  once  or 
twice  a  year  or  whenever  a  room  seems  to  be  getting  too  much 
or  too  little  air.  The  supervisor  of  hygiene  may  do  this  or 
teach  principals  how  to  do  it.  The  velocity  of  the  incoming 
air  should  be  taken  as  the  average  of  several  measurements  at 

1  The  sling  psychrometer,  or  hygrometer,  especially  the  one  made  by  Max 
Kohl,  is  a  good  instrument  for  measuring  the  percentages  of  moistures.  Tables 
must  be  used,  however,  to  calculate  the  amount.  The  best  simple  instrument 
which  dispenses  with  calculation  and  can  be  read  directly  is  the  hair  hygrom- 
eter, as  easily  read  by  a  teacher  or  pupil  as  a  clock.  (Made  by  the  Central 
Scientific  Co.,  Chicago.) 


350  EDUCATIONAL  HYGIENE 

several  points  on  the  four-square-foot  surface  of  the  mouth  of 
the  duct.  This  average  velocity  for  the  whole  area  should  be 
multiplied  by  the  area  in  square  feet  to  get  the  quantity 
entering  for  a  given  length  of  time,  say  thirty  seconds.  This 
product  divided  by  the  number  of  pupils  and  teachers  in  the 
room  will  give  the  average  amount  coming  in  for  each  person. 

(6)  Blackboards. — Blackboards  should  be  of  slate,  al- 
though glass  and  composition  boards  are  being  slowly  per- 
fected. In  the  standard  classroom,  blackboards  will  be 
placed  on  the  rear,  right,  and  front  walls.  They  must  be 
written  on  by  both  teacher  and  pupils  and  should  conse- 
quently be  wide  enough  to  meet  the  needs  of  both.  The 
front  board  may  well  be  5^  feet  wide,  the  others  4  feet,  or 
perhaps  3^  feet,  to  avoid  as  much  light-absorption  as  possible. 
In  primary  rooms  the  bottoms  of  the  boards  should  be  not 
higher  than  about  26  inches  from  the  floor,  and  in  upper 
grades  and  high  school  about  30  to  38  inches  above  the  floor. 
The  increase  in  height  may  be  graded  between  these  ex- 
tremes. Hard,  dustless  chalk  should  be  used,  and  wire 
hinged  screens  should  cover  chalk  troughs.  Curtains  on  rollers 
of  a  light  color  may  be  used,  as  suggested,  to  cover  boards 
when  not  in  use,  in  order  to  prevent  light-absorption.  Soft, 
dustless  erasers  should  be  used  and  these  should  be  cleaned 
once  a  week  or  of  tener  by  the  janitor  or  other  persons.  Where 
there  is  a  vacuum-cleaning  system,  erasers  furnish  no  problem. 
Dresslar  in  his  "School  Hygiene"  gives  several  good  sugges- 
tions along  this  line. 

(7)  Water. — Some  have  set  the  standard  of  hot  and  cold 
running  water  in  a  fixed  bowl  in  every  classroom  or  cloak- 
room, and  certainly  this  will  come  in  all  of  the  most  sanitary 
schools.  Pupils  need  plenty  of  water  to  drink  and  they  need 
to  keep  clean.  Drawing  and  other  forms  of  work  require 
water  and  some  forms  make  pupils  dirty  enough  to  require 
washing.  Where  the  basin  is  located  in  the  cloak-room  the 
floor  may  be  made  of  the  same  composition  as  that  of  the 
corridors — ^cement,  tile,  asphalt,  or  composition.  The  cold- 
water  faucet  should  be  equipped  with  a  sanitary  drinking- 


Moulthrop  school  desk-chair,  adjustable 
and  movable,  new  style 


The  "panic  bolt"  illustrated  in  frontispiece 


SCHOOL   SANITATION   STANDARDS  351 

fountain.  Rural  schools  may  now  have  drinking-fountains, 
as  shown  in  another  chapter.  Common  cups  and  individual 
cups  should  go.  Common  towels  should  also  disappear  like  the 
old  feather  duster.  Paper  towels  are  now  cheap  and  efficient 
enough  to  be  provided  all  children.  Real  sanitary  habits  can- 
not come  without  them.  Soap  may  be  supplied  in  liquid 
form  from  automatic  containers.  Health  habits  cannot  be 
developed  with  no  opportunity  to  practise  health  acts.  Anti- 
Typhoid  Mary  habits  come  with  exercise. 

(8)  School  Desks. — School  desks  are  in  a  transitional 
stage  also.  They  should  provide  for  different  types  of  work 
than  formerly,  e.  g.,  manual  training;  they  must  be  individual; 
they  must  be  adjustable,  seat  and  desk;  they  should  be  thor- 
oughly sanitary  (neither  dust-catchers  nor  hard  to  clean  under) ; 
the  tops  should  be  adjustable  for  writing,  reading,  and  manual 
work;  and  many  are  now  demanding  that  they  be  movable 
on  the  floor.  The  Moulthrop  school  chair,  a  combined  seat 
and  desk,  is  about  the  best  type  that  at  the  present  meets 
the  last  and  several  other  of  the  standards.  The  top  can  be 
tilted  to  hold  a  book  while  a  pupil  is  reading  or  singing,  and 
it  can  be  moved  forward  and  backward  and  up  and  down. 
The  seat  part  is  not  yet  made  adjustable  but  is  made  in  dif- 
ferent sizes.  These  chairs  can  be  moved  by  pupils  to  any 
part  of  the  room,  as  the  teacher  or  janitor  wishes. 

For  a  seat  screwed  to  the  floor,  as  few  legs  to  interfere 
with  sweeping  and  cleaning  as  possible  should  be  provided — 
one  for  each  pupil,  instead  of  four  to  six,  as  is  customary,  if 
possible.  The  single-pedestal  combined  desk  and  seat  meets 
this  requirement  well,  the  base  being  a  large  oval  (front  and 
back),  closed  iron  standard.  Such  desks  must  be  well  put 
down  to  avoid  wiggling  by  the  pupil  on  the  seat  in  front. 

Dresslar  gives  twenty-one  excellent  standards  for  school 
desks  in  Monroe's  "Cyclopedia  of  Education,"  which  should 
be  observed  in  every  schoolhouse. 

IV.  Cleaning  and  Sanitation. — Cleanliness  is  the  first 
principle  of  sanitation.  Since  most  diseases  are  caused  by 
germs  and  since  these  are  best  eradicated  by  cleanliness,  we 


352  EDUCATIONAL   HYGIENE 

have  a  fundamental  law  of  school  sanitation:  Keep  every- 
thing as  clean  as  possible.  First,  we  must  have  clean  chil- 
dren with  clean  clothing  and  clean  and  filled  teeth.  This 
requires  tactful  work  on  the  part  of  school-teachers  and 
nurses,  and  co-operation  on  the  part  of  parents.  There  must 
inevitably  be  provided  in  many  places  school  baths  and  free 
school  dentistry.  Habits  of  personal  cleanliness  at  the  school 
must  be  inculcated  persistently,  such  as  cleaning  the  feet 
thoroughly  on  mats  and  scrapers  provided,  before  entering 
the  school,  using  a  handkerchief  (some  teachers  and  nurses 
have  used  handkerchief  as  well  as  tooth-brush  drills),  bathing 
at  least  once  a  week,  washing  thoroughly  before  coming  to 
school  and  at  school  when  necessary,  etc.  Hot  and  cold 
water  in  stationary  bowls  for  washing,  paper  towels,  and  liquid 
soap  are  requisites,  especially  in  toilet-rooms.  Second,  the 
school  must  be  in  a  clean  location  with  clean  air,  walks,  and 
yards.  Third,  the  janitor  must  be  trained  to  do  his  work  in 
the  best  way.  Feather  dusters  and  dry  sweeping  should  be 
abolished.  Vacuum  cleaning  should  be  provided  wherever 
possible.  Floors  should  be  oiled  with  a  light  oil  several  times 
during  the  year,  thoroughly  rubbed  in  and  then  carefully 
wiped  off.  Where  there  are  no  vacuum  cleaners,  oiled-hair 
filter  brushes  should  be  used  instead  of  brooms.  Every 
janitor  and  teacher  should  know  how  to  make  damp  or  oiled 
sawdust  for  sweeping,  and  teachers  should  demand  that  such 
a  sweeping  compound  be  used  to  keep  down  dust.  Dusting 
should  be  done  with  a  damp  or  oiled  cloth,  never  with  a  dry 
cloth  or  feather  duster.  All  floors  should  be  swept  daily 
and  windows  should  be  washed  often  enough  to  keep  them 
clean,  at  least  three  times  a  year.  Blackboards  should  be 
washed  once  a  week.  Toilet  seats  should  be  scrubbed  daily. 
Floors  should  be  scrubbed  frequently  if  they  are  not  oiled. 
Strange  to  say,  floors  may  be  scrubbed  with  oil  and  the 
floors  kept  fairly  white  and  clean  after  years  of  oiling.  As  a 
principal  I  once  had  the  teachers  vote  on  the  oiling  or  scrub- 
bing of  floors.     They  voted  for  scrubbing  without  the  use  of 


SCHOOL   SANITATION   STANDARDS  353 

oil,  but  in  a  month  or  two  voted  in  again  the  use  of  oil.  The 
janitor  knew  how  to  put  it  on  and  how  to  remove  the  part 
not  absorbed  by  the  wood,  so  skirts  were  little  injured.  The 
oil  kept  down  the  dust  and  kept  the  floor  from  wearing. 

Third,  the  promiscuous  use  of  pencils  should  be  abso- 
lutely prohibited.  One  or  two  outbreaks  of  diphtheria  and 
other  diseases  have  been  definitely  traced  to  this  pernicious 
custom  this  year.  It  is  hoped  that  medical  supervision  will 
permanently  kill  this  practise.  If  possible,  pencils  should 
never  be  collected  together,  not  even  in  numbered  recep- 
tacles, and  pupils  should  be  taught  to  avoid  putting  into  their 
mouths  the  pencils  of  others  or  anything  else  another  person 
has  had  in  his  mouth  or  possession,  with  few  exceptions. 
School-books  are  not  put  into  the  mouth  very  much  but 
should  probably  be  steriHzed  occasionally  by  heated  moist 
air.  Rules  along  this  line  can  be  worked  out  by  the  super- 
visors of  hygiene.^ 

V.  Sanitation  of  Special  Rooms  and  Features. — The  above 
principles  apply  fairly  well  to  all  rooms.  Toilets  furnish  a 
perpetual  problem  in  this  respect.  Some  of  the  newer  build- 
ings of  Chicago  and  other  cities  have  developed  the  tower 
construction  for  toilets,  one  toilet  on  each  floor  for  both  sexes, 
for  pupils  and  for  teachers.  The  towers  provide  separate 
ventilation  and  privacy,  and  seem  a  desirable  invention. 
Many  of  our  best  city  schools  are  taking  the  standard  of  a 
toilet-room  for  both  sexes  in  connection  with  each  class-room, 
so  teachers  may  have  better  control,  and  so  the  usual  mixture 
of  all  children  from  all  rooms  will  not  need  to  congregate  to- 
gether. The  best  practical  plan  for  most  schools  at  present  is 
to  have  dry,  well-lighted,  and  ventilated  basements  for  the 
large  toilet-rooms  and  to  have  smaller  ones  of  one  stool  each 
on  each  floor  for  both  sexes.  Separate  exhaust  fans  for 
toilets  are  necessary  in  large  buildings. 

The  number  of   toilet   seats  needed  is   standardized  at 

^  See  "  Man  and  the  Microbe,"  by  Winslow,  in  the  Popular  Science  Monthly 
for  July,  19 14. 


354  EDUCATIONAL  HYGIENE 

about  one  for  each  fifteen  girls  and  one  for  about  each  twenty- 
five  boys.  One  urinal  stall  for  each  thirty  boys  will  be  found 
sufficient,  if  the  younger  pupils  are  dismissed  earlier  than  the 
older  and  the  janitor  supervises  the  toilet-room. 

The  standards  given  by  Dresslar  in  Monroe's  "Cyclopedia 
of  Education"  are  here  again  recommended. 

In  conclusion,  let  us  steadfastly  keep  a  scientific  attitude 
of  mind  in  establishing  and  using  school  sanitation  standards. 
Carefully  controlled  research  and  experimentation  is  the  only 
true  method  of  advance. 


CHAPTER  XX 
RURAL  SCHOOL  SANITATION 

The  Need  for  Rural  School  Sanitation. — In  this  chapter^ 
only  those  features  of  school  sanitation  in  which  the  rural 
problem  differs  from  the  general  problem  will  be  discussed. 
The  difference  lies  principally  in  the  arrangements  and  equip- 
ment adopted  to  make  the  school  sanitary,  as  different  means 
must  be  employed  in  the  country  from  those  employed  in  the 
city.  Especially  is  this  true  in  the  one-teacher  schools.  Also, 
rural  school  sanitation  is  concerned  with  more  than  urban 
school  sanitation  on  account  of  its  wider  field  of  influence. 
The  following  principal  reasons  why  the  rural  school  building 
and  grounds  should  be  made  sanitary  may  well  be  reviewed: 

First:  So  that  they  may  be  as  attractive  as  possible  to  the 
pupils. 

Second:  So  that  the  health  of  the  school-children  and 
teachers  may  not  be  endangered. 

Third :  So  that  the  health  of  the  community  may  not  be 
endangered  through  diseases  disseminated  from  the  school  by 
the  children,  or  by  other  agencies  such  as  the  wind,  rain,  and 
animals,  particularly  insects. 

Fourth:  So  that  the  children  may  learn  directly  what 
sanitation  means,  and  may  acquire  sanitary  habits  in  the 
school  for  use  at  home,  both  while  pupils  in  school  and  in 
their  lives  after  the  school-days  are  over. 

Fifth:  As  a  demonstration  of  sanitation  and  of  sanitary 
equipment  to  the  citizens  of  the  school  district. 

All  of  these  factors  should  be  borne  in  mind  in  planning 
the  rural  school.     Consideration  is  seldom  given  to  the  first, 

'See  also  chapter  XI  on  "Rural  School-Health  Administration." 

355 


356  EDUCATIONAL  HYGIENE 

since  it  is  generally  supposed  that  children  take  little  notice 
of  the  sanitary  arrangements  of  the  school  plant.  This  is 
true  only  to  a  certain  extent.  The  insanitary  outhouse  is 
very  repulsive  to  the  children,  especially  to  those  who  come 
from  homes  where  clean,  comfortable  ones  are  provided.  They 
are  much  more  repulsive  at  an  early  age  than  later  when  the 
child  has  grown  accustomed  to  the  objectionable  conditions. 
President  John  R.  Kirke,  of  the  Kirksville,  Missouri,  Normal 
School,  tells  of  a  boy  who  wanted  to  attend  a  "model  one- 
teacher  rural  school"  maintained  on  the  normal  campus  as  a 
demonstration  and  training  school  for  students  preparing  for 
rural  teaching.  Children  are  brought  in  to  the  school  each 
day  in  one  large  transportation  wagon.  This  boy,  nine  years 
old,  lived  three  miles  from  the  model  school  and  not  on  the 
wagon  route.  He  was  willing  to  tramp  in  to  the  school  each 
day  if  allowed  to  attend,  giving  as  his  reason  for  not  liking 
the  district  school  near  his  home,  "They  haven't  got  any 
modern  toilets  out  there." 

The  second  reason  is  the  one  usually  given  for  having  a  san- 
itary plant,  but  it  is  of  no  more  importance  than  some  of  the 
others.  Much  sickness  on  the  part  of  school-children  comes 
directly  from  the  school — ^poor  lighting,  bad  ventilation,  over 
or  under  heating,  being  some  of  the  causes.  Many  dis- 
eases are  contracted  from  other  children  either  directly  or 
indirectly.  Insanitary  outhouses  are  often  the  cause  of  the 
pollution  of  the  water  supply  of  neighboring  farms  or  the 
source  of  disease  spread  about  by  flies  and  other  insects. 
Only  recently  typhoid  fever,  which  caused  the  death  of  two 
young  women  in  the  same  family  in  Kentucky,  was  found  to 
have  resulted  from  the  use  of  spring  water  contaminated  from 
a  school  privy  located  a  short  distance  away. 

The  fourth  and  fifth  reasons  seem  to  me  to  be  very  impor- 
tant. If  the  child,  unaccustomed  to  sanitary  practises  at 
home,  acquires  sanitary  habits  at  the  school  and  becomes 
familiar  with  sanitary  equipment,  he  will  probably  do  what 
he  can  to  provide  himself  with  similar  improvements  at  his 


RURAL   SCHOOL   SANITATION  357 

parents'  home  and  later  at  his  own  home.  In  this  way  the 
school  assists  in  the  great  campaign  for  improved  sanitation 
now  being  conducted  throughout  the  country.  It  assists 
not  only  the  famihes  represented  in  the  school  but  also  the 
entire  community,  for  its  sanitary  equipment  is  to  the  com- 
munity an  actual  demonstration.  In  many  parts  of  the 
country  Httle  headway  has  yet  been  made  in  securing  the 
adoption  of  facihties  for  making  the  farm  and  farm  home 
sanitary.  Several  diseases  that  have  almost  entirely  disap- 
peared from  cities  with  proper  sewage-disposal  systems  are 
still  rampant  in  rural  districts.  Hookworm,  with  which 
probably  one  million  persons  in  the  United  States  are  now 
suffering,  is  confined  wholly  to  rural  territory,  and  typhoid, 
while  not  wholly  a  rural  disease,  is  more  prevalent  in  the 
country  than  in  the  city.  When  occurring  in  the  city  it  is 
found  usually  to  have  come  from  contaminated  food  supplies, 
or  milk  or  water  brought  in  from  the  country.  It  is  there- 
fore desirable  that  country  life  be  made  more  sanitary,  not 
only  for  the  benefit  of  those  living  in  the  country  but  also 
for  city  people  as  well.  It  cannot  be  accomplished  wholly 
by  preaching  the  dangers  of  disease,  but  must  be  accom- 
panied by  actual  demonstrations  of  sanitary  equipment. 
This  it  is  the  privilege  and  duty  of  the  school  to  do.  A  sani- 
tarily equipped  farmhouse  is  a  demonstration  only  to  the 
few  who  have  access  to  the  house;  the  sanitarily  equipped 
school  is  a  demonstration  to  all,  because  all  may  visit  the 
school. 

It  has  been  the  experience  of  schools  where  such  improve- 
ments have  been  installed  that  many  persons  have  come  to 
inspect  the  equipment.  A  few  years  ago  the  Farragut  School, 
at  Concord,  Tennessee,  installed  a  water  system,  water  being 
obtained  from  a  neighboring  spring.  Sanitary  closets,  show- 
er-baths, and  drinking-fountains  were  placed  in  the  school. 
Few  farmers  of  the  surrounding  country  had  ever  seen  such 
provisions  before  their  installation  in  the  school,  but  there 
are  very  few  now  who  have  not  seen  the  school  equipment; 


358  EDUCATIONAL   HYGIENE 

and  many,  since  seeing  it,  have  installed  similar  equipment  in 
their  own  homes.  When  the  principal  of  a  small  consolidated 
school  in  a  backward  community  in  northern  Louisiana  had 
his  schoolboys  make  screens  for  the  schoolhouse  windows, 
and  for  the  windows  of  his  house,  which  was  located  on  the 
school  grounds,  he  thereby  introduced  screens  into  the  com- 
munity. None  had  been  used  before.  The  neighbors  of  the 
school  saw  the  benefits  immediately,  and  the  windows  and 
doors  of  probably  every  house  in  the  territory  served  by  the 
school  are  now  screened.^ 

In  selecting  equipment  for  the  rural  school  it  is  necessary 
to  bear  in  mind  that  it  is  to  serve  a  wider  sphere  of  useful- 
ness than  that  of  making  the  school  sanitary.  Its  adaptabil- 
ity to  the  home  should  receive  strong  consideration.  When 
equipment  suitable  to  the  home  as  well  as  to  the  school  can 
be  obtained,  it  should  in  general  be  selected  in  preference  to 
equipment  suitable  for  school  use  only.  Equipment  should 
be  obtained,  whenever  possible,  within  the  reach,  so  far  as  the 
cost  is  concerned,  of  the  average  family  of  the  community. 

The  Sanitary  Rural  School  Plant. — In  locating,  building, 
and  equipping  the  rural  school  the  following  points  relative 
to  sanitation  should  be  observed: 

(i)  The  yard  should  be  sufficiently  dry  to  be  used  as  a 
playground  at  all  times  except  on  unusually  wet  days. 

(2)  The  building  must  be  well  enough  built  to  be  comfort- 
able on  cold,  windy,  or  wet  days. 

(3)  The  building  must  be  properly  heated,  ventilated,  and 
lighted,  and  the  interior  decorated  in  the  colors  most  restful 
to  the  eyes. 

(4)  Proper  arrangements  must  be  made  for  cleaning  the 
building. 

(5)  A  supply  of  pure  drinking  water  must  be  available, 
also  suitable  arrangements  for  washing  hands  and  faces. 

1  See  bulletin  on  "  Consolidation  of  Rural  Schools  and  Transportation  of 
Pupils  at  Public  E.xpense,"  by  the  writer.  (Bureau  of  Education,  Washington, 
D.  C.) 


RURAL   SCHOOL   SANITATION  359 

(6)  The  grounds  must  be  free  from  filth  of  any  sort,  es- 
pecially from  decaying  food  material  or  animal  refuse. 

(7)  Clean,  sanitary  toilets  must  be  provided. 

The  School  Lot.- — The  school,  if  possible,  should  be  lo- 
cated on  a  site  naturally  drained,  so  that  artificial  drainage  is 
unnecessary.  If  such  a  lot  cannot  be  secured,  the  site  should 
be  thoroughly  underdrained  with  tile  pipe.  Open  ditches 
should  not  be  made  on  the  school  grounds,  as  they  are  not 
only  unsightly  but  are  always  an  attraction  to  small  boys, 
and  wet  feet  and  clothes  are  bound  to  follow.  Even  with 
the  yard  well  drained,  gravel,  board,  stone,  or  cement  walks 
should  be  built  from  the  road  to  the  doors  of  the  building 
and  from  the  building  to  the  outhouses,  so  that  the  children 
may  keep  their  feet  dry  under  all  conditions.  Moreover, 
the  space  under  the  building  should  be  thoroughly  drained,  as 
well  as  the  yard  itself. 

Lighting. — Little  need  be  said  in  this  chapter  regarding 
the  building  itself,  since  what  has  been  said  in  the  chapter  in 
this  book  on  school  buildings  applies  to  rural  schools  as  well 
as  to  city  schools.  There  are,  however,  special  features  con- 
cerning the  lighting,  heating,  and  ventilation  of  the  rural 
school,  particularly  the  one-room  school,  that  require  mention 
here. 

The  great  majority  of  rural  one-teacher  schools  are 
lighted  from  windows  on  both  the  right  and  left  sides  of  the 
room;  many  have  windows  on  three  sides;  and  one-room 
school  buildings  with  windows  on  four  sides  are  not  uncom- 
mon. The  best  arrangement  is  generally  conceded  to  be  with 
windows  placed  on  the  left  and  rear.  Where  the  windows  are 
placed  on  opposite  sides,  a  cross-light  results  which  is  assumed 
to  be  tiresome  to  the  eyes.  In  buildings  with  this  arrange- 
ment, shades  should  be  provided,  so  that  the  light  from  the 
lower  half  of  right-hand  windows  may  be  cut  out.  Under  no 
circumstances  should  desks  be  placed  facing  windows.  Light 
coming  to  the  children  from  directly  in  front  of  them  is  injuri- 
ous to  the  eyes,  and  while  it  may  not  always  cause  permanent 


360  EDUCATIONAL  HYGIENE 

injury  it  does  cause  eye-strain  and  headache,  and  renders  the 
cliildren  unfit  for  the  best  work  possible.  Whenever  con- 
venient, the  building  should  be  placed  with  the  windows  facing 
the  east  or  west  so  that  sunlight  may  enter.  The  windows 
should  be  placed  high,  extending  nearly  to  the  ceih'ng,  and  the 
total  window  space  should  be  equal  to  or  exceed  one-fifth  of 
the  floor  space.  If  the  walls  are  tinted  a  light  gray,  a  soft, 
diffused  light  is  distributed  evenly  about  the  room,  restful  to 
the  eyes  and  helpful  in  permitting  the  pupils  to  work  with  the 
greatest  ease.  Glossily  finished  walls  or  blackboards  must  be 
avoided,  since  they  cause  a  direct  reflection  instead  of  a  dif- 
fusion of  light.  Windows  on  the  right  and  rear  should  be  high 
and  of  single  sash,  easily  opened  for  ventilation  and  air  move- 
ment. 

Heating  and  Ventilation. — The  usual  method  of  heating 
the  small  country  school  is  by  the  means  of  a  single  stove 
placed  in  the  centre  of  the  room  with  a  stovepipe  ascending 
directly  upward  into  a  brick  chimney  the  base  of  which  is  sup- 
ported on  the  cross-beams  in  the  ceiling.  This  is  uneconom- 
ical, since  much  of  the  heat  is  lost  through  the  chimney.  It  is 
unsatisfactory  in  many  ways,  but  particularly  because  of  the 
uneven  temperature  resulting  in  the  room,  especially  on  cold 
and  windy  days.  A  slight  improvement  is  made  when  the 
chimney  is  placed  at  one  end  of  the  building,  the  stove  near 
the  other  end,  and  the  stovepipe  suspended  from  the  ceiHng  the 
length  of  the  room.  A  much  greater  improvement  is  easily  and 
cheaply  made  by  surrounding  the  stove  with  a  sheet-iron 
jacket  standing  a  few  inches  from  the  floor  and  projecting  a 
foot  or  so  above  the  stove.  All  direct  radiation  is  then  cut 
off;  the  air  inside  the  jacket  is  heated,  rises,  spreads  about 
near  the  ceiling,  and  gradually  settles  downward.  Cold  air 
from  near  the  floor  is  drawn  in  under  the  jacket.  As  a  result 
a  circulation  is  created  which  results  in  comparatively  even 
temperature  throughout  the  room.  If  the  jacket  fits  about 
the  stove  properly,  the  stove  may  be  placed  in  one  cor- 
ner of  the  room  with  entirely  satisfactory  results,  provided 


RURAL   SCHOOL   SANITATION 


361 


the  building  is  ordinarily  weather-tight.  Stoves  built  with 
jackets  may  be  purchased  at  very  reasonable  prices  and  are 
usually  more  satisfactory  than  the  ordinary  stoves  with  make- 
shift jackets. 

Such  an  arrangement  as  just  described  does  not  especially 
improve   the   ventilation.     However,   jacketed   stoves   with 


I 


COLO  AIR  DUCT  ■ 
WATER  TANK 
AOO.CAL 


DRYING  ROOM 


%J 


QCASMUCR  DYNAMi 

(~)WATtR  COOLER 


4YMNASIUM    l2)tX23 


»         --VI 


«iR  PRCSSURt/ 
MACHINC  . 


BASEMENT  PLAN,  MODEL  RURAL  SCHOOL,   KIRKSVILLE,  MO. 
Courtesy  United  States  Bureau  of  Education 

ventilating  attachments  are  manufactured  by  several  firms 
and  are  quite  satisfactory.  In  these  the  jacket  fits  closely  to 
the  floor,  with  an  opening  either  through  the  wall  or  through 
the  floor  so  that  fresh  air  from  outside  the  building  may  be 
drawn  in  to  replace  the  heated  air  rising  from  inside  the 
jacket.  Thus  a  constant  supply  of  fresh  air  is  being  brought 
into  the  room.  Provision  must  be  made,  however,  for  the 
removal  of  the  foul  air  coming  from  the  lungs  and  bodies  of 
the   children.     This   foul   air,    as   is   generally   understood, 


362 


EDUCATIONAL  HYGIENE 


settles  to  the  floor  of  the  room.  It  is  most  easily  removed, 
if  the  chimney  is  of  brick  and  extends  to  the  floor  of  the 
building,  by  removing  a  few  bricks  in  the  bottom  of  the  chim- 
ney near  the  floor.  An  upward  draft  is  created  in  the 
chimney  by  the  heat  from  the  stovepipe.  This  draws  the 
foul  air  from  the  floor.     A  circulation  is  created,  the  heat  of 


FIRST  FLOOR  PLAN,  MODEL  RURAL  SCHOOL,  KIRKSVILLE,  MO. 

Courtesy  United  States  Bureau  of  Education 

the  stove  drawing  in  fresh  air  from  outside  the  building, 
causing  it  to  ascend  and  spread  throughout  the  room.  It  is 
then  taken  into  the  lungs  of  the  children,  exhaled,  and  finally 
settles  to  the  floor,  from  whence  it  is  drawn  off  through  the 
chimney  by  the  waste  heat  in  the  stovepipe.  If  the  brick 
chimney  does  not  extend  to  the  floor,  an  escape  for  the  foul 
air  is  made  by  use  of  a  large  stovepipe  extending  from  within 
a  few  inches  above  the  floor  upward  to  the  chimney,  surround- 
ing the  regular  stovepipe  before  it  enters  the  chimney.  Tests 
made  with  these  jacketed  stoves  and  ventilating  attachments 


A  model  consolidated  school  building 

The  old  single-room  rural  schools  are  rapidly  being  abandoned,  children  being  transported 
in  school  hacks  to  consolidated  schools 


Part  of  the  basement  of  a  renovated  rural  school 

Note  end  of  pressure-tank,  sink,  drinking-fountain,  and  wash-bowl 

From  Dresslar's  "  Rural  Schoolhouses  and  Grounds  " 


RURAL   SCHOOL   SANITATION 


363 


prove  them  to  be  both  satisfactory  and  economical.  The 
stove  may  be  placed  in  one  of  the  corners  of  the  room  as  much 
out  of  the  way  as  possible  and  it  will  heat  the  room  to  a  suffi- 
ciently even  temperature  and  supply  every  part  of  it  with 
fresh  air.     Mere  shields  of  iron  to  protect  the  nearest  pupils 


i — 


m 


CASOLINC 


SANITABV    ^ 


Q 


^WASH  BOWL 


_4S  XZOr 
SKV  LIGHT 


ATTIC  PLAN  "ST   side 

ATTIC  PLAN,  MODEL  RURAL   SCHOOL,  KIRKSVILLE,  MO. 
Courtesy  United  States  Bureau  of  Education 

from  the  heat  are  not  "jackets"  and  do  not  provide  for  thor- 
ough movement  of  the  air. 

The  writer  has  seen  several  one-teacher  schools  heated 
with  ordinary  hot-air  furnaces  placed  in  cellars.  This  neces- 
sitates the  digging  of  cellars  and  is,  of  course,  somewhat  more 
expensive,  although  often  the  cellars  may  be  used  for  wood- 
work shops,  for  agriculture,  or  other  purposes.  The  plan  has 
the  advantage  that  all  heating  apparatus  is  removed  from  the 
schoolroom  and  so  much  space  saved.  The  room  is  no  more 
satisfactorily  heated,  however,  than  with  the  jacketed  stove. 


364  EDUCATIONAL  HYGIENE 

and  no  better  ventilation  is  secured.  Probably  the  extra 
expense,  except  where  two  or  more  rooms  are  to  be  heated, 
will  not  ordinarily  justify  the  installation  of  the  hot-air  fur- 
nace except  where  new  buildings  are  erected. 

Ventilation  without  the  jacketed  stove  or  hot-air  furnace 
is  difficult  to  accomplish.  With  the  ordinary  stove  it  is  prob- 
ably best  obtained  by  arranging  the  windows  so  that  they  may 
be  lowered  from  the  top,  or  by  using  a  window-board.  This 
is  a  board,  eight  to  twelve  inches  wide,  fitted  into  the  lower 
part  of  the  window-frame  on  the  inside  of  the  sash.  It  slopes 
inward  so  that  the  top  is  four  or  five  inches  from  the  sash. 
When  the  window  is  raised  at  the  bottom,  fresh  air  enters 
between  the  window  and  the  board  and  is  projected  upward 
into  the  room  in  such  a  way  that  no  draft  is  created  on  the 
children.  Instead  of  a  board,  window-glass  in  a  special  sash 
is  frequently  used.  This  has  the  advantage  of  cutting  out 
no  light.  Rooms  should  be  flushed  with  fresh  air  at  recesses 
and  frequently  at  other  times.  Direct  drafts  on  the  children 
as  seated  should  be  avoided. 

Cleaning  the  Schoolroom. — The  method  of  cleaning  the 
ordinary  country  school  building  is  given  little  attention. 
In  probably  more  than  half  of  the  one-teacher  country 
schools  the  janitor  work  is  done  by  the  teacher  or  by  one  of 
the  older  boys.  The  buildings  are  swept  usually  once  or  twice 
a  week  and  with  the  corn  broom — sometimes  the  floor  being 
sprinkled  with  water  before  the  sweeping.  After  the  dust 
has  settled  it  is  customary  to  dust  off  the  furniture  with  a 
feather  duster,  driving  the  dust  into  the  air  to  settle  again  on 
the  desks  and  chairs.  It  is  almost  needless  to  say  this  is  un- 
satisfactory and  insanitary. 

It  will  be  many  years  before  the  great  majority  of  country 
schools  are  supplied  with  many  of  the  modern  sanitary  ap- 
pliances for  cleaning  now  being  used  in  city  schools.  The 
sweeping  will  be  done  for  some  time  to  come  with  the  ordi- 
nary broom.  Methods  of  sweeping,  however,  may  be  im- 
proved.    SprinkHng  the  floor  is  effectual  in  preventing  the 


Looking  into  library  and  cloak-rooms  of  the  Cross  Roads  School 
From  Dresslar's  "Rural  Schoolhouses  and  Grounds,"  U.  S.  Bureau  of  Education 


Corner  of  kitchen,  rural  school  in  Louisiana 


RURAL   SCHOOL   SANITATION  365 

raising  of  dust  but  it  binds  the  dirt  to  the  floor  and  only  part  of 
it  is  removed.  A  simple  improvement  consists  in  the  use  of 
moist  sawdust  sprinkled  on  the  floor  and  swept  along  with  the 
dirt.  This  holds  the  dust  and  leaves  the  floor  clean.  Many- 
patented  materials  are  on  the  market  for  use  on  the  floor  to  pre- 
vent a  dust  when  sweeping.  Most  of  them  may  be  used  several 
times.  They  are  cheap,  economical,  and  satisfactory  in  every 
way.  The  oil  brush  is  also  cheap  and  satisfactory.  This  is 
a  sweeping-brush  carrying  a  reservoir  from  which  kerosene 
oil  is  released  slowly  enough  to  keep  the  bristles  of  the  brush 
moistened.  Sweeping  with  it  is  clean  and  dustless.  Even 
with  the  use  of  patented  dust-holders  or  of  the  oil  brush,  the 
floor  must  occasionally  be  washed  with  hot  suds.  Much  of 
the  dirt  may  be  kept  out  of  the  building  by  providing  some 
kind  of  iron  scraper  at  the  stoop,  and  encouraging  the  boys 
and  girls  to  scrape  carefully  the  extra  mud  and  dirt  from 
their  shoes  before  entering.  The  scraper  and  a  corn-husk  or 
bristle  mat  at  the  door  would  help  keep  the  floor  clean,  and 
their  use  might  establish  habits  in  some  of  the  boys  and  girls 
which  would  be  practised  at  their  homes,  and  for  which  many 
overworked,  tired,  and  weary  mothers  would  thank  the 
teacher. 

The  ordinary  feather  duster  should  never  be  used.  Large 
cloths  moistened  in  water  or  oil  should  be  used  instead,  and 
with  them  the  desks,  chairs,  and  all  furniture  should  be  care- 
fully wiped  each  day. 

The  Water  Supply. — The  dangers  from  impure  water, 
dirty  water,  the  common  drinking-cup,  and  the  unclean 
drinking-cup  are  discussed  elsewhere  in  the  book,  so  that 
nothing  further  needs  to  be  said  here.  In  regard  to  the  sup- 
ply, it  may  be  said  that  every  country  school  should  have  a 
handy  source  of  pure  water  either  on  the  school  grounds  or 
near  the  school  grounds,  and  under  the  authority  of  the  school 
officials,  so  that  the  purity  of  the  water  may  be  protected. 
If  the  source  of  the  water  supply  is  a  well,  it  should  be  so 
located  that  pollution  from  outhouses  or  barnyards  may  not 


366  EDUCATIONAL  HYGIENE 

take  place.  It  must  be  remembered  that  pollution  may 
result  from  surface  water;  therefore  the  well  should  be  so 
constructed  that  surface  water  cannot  enter.  To  prevent 
all  foreign  matter  from  getting  in,  a  tight  cover  should  be 
placed  over  the  well.  Pollution  may  also  take  place  from  soil 
— water  percolating  through  the  soil  from  a  source  of  con- 
tamination several  hundred  feet  away.  This  will  take  place 
when  the  rock  strata  slope  from  the  source  of  contamination 
toward  the  well,  and  it  must  be  borne  in  mind  that  the  sur- 
face of  the  land  and  the  underlying  rock  strata  are  often  not 
parallel  and  many  times  are  found  sloping  in  opposite  direc- 
tions. 

Water  collected  from  the  roof  of  the  buildings  and  stored 
in  cisterns  is  used  at  many  schools.  Where  this  water  is 
used,  some  arrangements  should  be  provided  so  that  the  first 
water  coming  from  the  roof  at  the  beginning  of  each  storm 
will  not  enter  the  cistern.  After  an  interval  of  several  days 
without  rain,  the  roof  is  always  covered  with  more  or  less 
dust;  it  is  also  usually  soiled  from  the  droppings  of  birds. 

Whatever  the  source  may  be,  a  supply  of  pure,  cool  drink- 
ing water  should  be  kept  where  it  can  be  easily  reached  by 
the  children  at  all  times.  The  common  drinking-cup  should 
not  be  used.  If  the  water  is  kept  in  a  pail,  a  cover  should 
be  provided,  also  a  dipper  with  a  long  handle  for  transferring 
the  water  from  the  pail  to  the  drinking-cup.  Much  more 
satisfactory,  however,  is  a  water-tank  with  a  faucet  near  the 
bottom  so  that  the  water  may  be  drawn  out  without  the  use 
of  the  dipper.  Such  tanks  are  inexpensive.  The  double 
tanks,  with  an  air  space  between  the  two  walls,  keep  the  heat 
out  of  the  water  for  a  much  longer  period  than  the  others,  but 
are  of  course  more  expensive.  Several  tanks  are  on  the  mar- 
ket with  an  attachment  for  drinking  similar  to  the  bubbhng 
fountain. 

By  use  of  the  pneumatic  pressure-tank  running  water  may 
be  had  for  the  country  school  at  a  very  much  lower  cost 
than  is  usually  supposed.     A  metal  tank,  the  size  of  the  ordi- 


Sanitary  drinkin^-fountains  for  rural  schools 


\ 


RURAL   SCHOOL   SANITATION 


3^7 


nary  kitchen  hot-water  tank  or  larger,  is  buried  in  the  ground 
below  the  frost  line  to  act  as  a  reservoir  and  pressure- tank 
combined.  It  is  connected  with  a  force-pump  at  the  well 
and  with  the  drinking-fountain  in  the  schoolroom.  Both 
pipes  to  the  tank  must  be  connected  at  the  lowest  part  of  the 
tank.  Water  is  pumped  into  the 
tank  from  the  well  by  the  force- 
pump.  The  tank  is  already  full 
of  air,  which,  as  more  and  more 
water  is  forced  in,  becomes  com- 
pressed, forming  a  pressure  on 
the  surface  of  the  water  and  in- 
creasing until  it  is  no  longer 
possible  to  force  in  more  water. 
This  pressure  will  force  the  water 
through  the  supply  pipes  up  to 
the  drinking-fountain.  This 
form  of  water-tank  is  much  more 
satisfactory  than  an  elevated 
tank  inside  or  on  top  of  the 
building.  There  is  always  suffi- 
cient "boy  power"  around  the 
country  school  to  get  the  tank 
filled  with  pressure  great  enough 
to  supply  the  building  with  running  water.  Under  ordinary 
conditions  five  minutes'  pumping  a  day  will  furnish  plenty  of 
water  for  drinking  purposes,  and  ten  minutes'  if  a  water-flush 
closet  is  used. 

Such  tanks  become  occasionally  "water-logged,"  that  is, 
the  air  becomes  dissolved  in  the  water  and  carried  away 
until  not  enough  is  left  to  furnish  the  required  pressure. 
Therefore  it  is  necessary  to  have  some  means  of  pumping  in 
air,  either  with  the  water  or  by  a  hand  air-pump. 

The  pneumatic  pressure-tank,  pump,  piping,  and  drinking- 
fountain  can  be  purchased  for  from  $ioo  to  $250.  With  it 
not  only  may  the  sanitary  drinking-fountain  be  provided  but 


SANITARY  DRINKING-FOUNTAIN, 
RUNNING  WATER  IN  WASH- 
BOWLS AND  FLUSH-TOILETS  BY 
MEANS  OF  AN  ORDINARY  FORCE- 
PUMP 

From  Dresslar's  "  Rural  Schoolhouses  and 
Grounds."  Courtesy  Bureau  of  Edu- 
cation 


368  EDUCATIONAL  HYGIENE 

also  a  convenient  sink  for  washing  hands,  and  sanitary  indoor 
closets  instead  of  the  ordinary  outhouses. 

Toilets. — The  most  difficult  problem,  and  the  one  con- 
cerning which  comparatively  little  has  been  done,  is  that  of 
supplying  sanitary  closets.  At  thousands  of  country  schools 
in  the  United  States  to-day,  no  closets  of  any  kind  are  pro- 
vided and  children  must  resort  to  the  shelter  of  neighboring 
woods.  In  thousands  of  others  closets  are  provided  but 
they  are  so  filthy  that  the  children  prefer  the  woods. 

The  great  majority  of  one-teacher  country  schools  will 
probably  continue  to  use  the  outhouse  privy  for  several  years 
to  come,  and  when  properly  constructed  and  cared  for  it  may 
be  satisfactory. 

The  sanitary  privy  should  be  so  constructed  that  its 
use  will  not  be  disagreeable  to  the  user,  and  so  that  the  ex- 
creta will  be  protected  from  any  agencies  which  might  dis- 
seminate disease-germs  from  them,  such  as  the  rain,  hogs, 
insects,  etc.  The  closet  itself  should  be  made  tight,  with  a 
close-fitting  door,  a  small  window  for  light,  preferably  over 
the  door,  and  an  opening  near  the  top  for  ventilation.  In 
States  where  snow  and  severe  cold  are  uncommon,  one  opening 
covered  with  a  wire  insect-netting  is  sufficient.  In  the  closet 
should  be  placed  a  permanent  box  in  which  a  supply  of  earth 
or  lime  should  be  kept,  to  be  used  every  time  the  closet  is 
used.  The  inside  walls  should  be  painted,  and  sprinkled  with 
sand  while  the  paint  is  yet  fresh,  so  that  a  rough  surface  will 
be  formed  on  which  pupils  and  others  cannot  write  with 
pencils.  The  receptacle  should  be  made  tight,  with  hinged 
covers,  so  that  as  little  odor  as  possible  may  enter  the  closet. 

Probably  the  best  form  of  the  receptacle  for  all  States 
where  severe  freezing  does  not  take  place  consists  of  a  tight 
box  the  floor  of  which  is  a  continuation  of  the  floor  of  the 
closet,  and  with  a  hinged  door  on  the  rear  of  the  closet  open- 
ing outward  and  upward.  In  this  box  is  placed,  under  each 
cover,  a  galvanized  iron  or  heavy  tin  bucket  or  tub  to  hold 
the  excreta.    These  buckets  should  be  taken  out  once  or  twice 


I 


RURAL   SCHOOL   SANITATION 


369 


jW^ 


a  week  and  the  contents  buried  in  a  place  where  they  can- 
not contaminate  the  water  supply  of  the  school  or  neighboring 
farms.  The  receptacle  should  have  a  small  opening  for  the 
escape  of  odors,  but  this  should  be  covered  with  a  netting  to 
prevent  the  entrance  of  flies 
or  other  insects.  In  colder 
countries  where  freezing 
would  make  this  arrange- 
ment impracticable,  a 
water-tight  cesspool  should 
be  built  for  a  receptacle, 
except  where  the  soil  is  of 
such  a  character  as  to 
furnish  a  natural  under- 
drainage,  and  where  to  do 
so  admits  no  danger  of 
pollution  of  water  used  for 
household  purposes  or  for 
farm  stock.  In  such  a  case 
an  excavation  or  pit  may 
be  made  under  the  closet, 
deep  enough  so  that  the 
excreta  cannot  be  washed 
out.  Whether  the  cesspool 
or  excavation  is  used,  both  must  be  covered  tightly  so  that 
rain,  water,  and  animals,  particularly  insects,  are  prevented 
from  entering. 

After  each  time  the  privy  is  used,  earth,  ashes,  or  lime 
should  be  thrown  into  the  receptacle  to  cover  the  excreta. 
The  earth  used  should  be  of  rather  a  loamy  nature,  if  possible, 
and  porous.  Sandy  soil  is  of  little  value.  A  heap  of  earth 
should  be  collected  in  summer  and  dried  in  the  sun  for  winter 
use.  Lime  is  much  better  than  earth.  Where  the  cesspool 
or  buckets  are  used,  a  few  inches  of  water  may  be  kept  in  the 
receptacle;  this  aids  the  excreta  in  fermenting  and  lique- 
fying.    When  this  is  done,  a  half-pint  of  kerosene  oil  should 


KENTUCKY  SANITARY  PRIVY.    VERTICAL 
SECTION  OF  TANK  AND  HOUSE 

From  Dresslar's   "  Rural  Schoolhouses  and 
Grounds  " 


370  EDUCATIONAL  HYGIENE 

be  kept  on  the  surface  of  the  water  to  repel  insects.  A 
five-per-cent  solution  of  crude  carbolic  acid  or  a  solution  of 
creosol  may  be  used. 

In  warm  climates  the  closets  should  be  placed  some  dis- 
tance from  the  schools.  Separate  buildings  should  be  pro- 
vided for  boys  and  girls  and  the  entrances  should  be  screened 
to  insure  privacy.  In  some  cases  the  closets  must  be  placed 
in  the  same  building.  When  this  is  necessary,  a  double  par- 
tition should  separate  the  boys  from  the  girls  and  a  board 
fence  at  least  six  feet  high  and  extending  from  the  building 
at  least  twenty  feet  should  separate  the  entrances.  In 
northern  States  closets  are  often  placed  in  an  addition  to  the 
school  building  which  contains  also  the  coal  or  wood  supply. 
When  the  fuel-room  is  between  the  schoolroom  and  the  closets 
this  plan  is  satisfactory,  provided  proper  care  is  used  in  the 
closets.  The  closets  may  be  entered  either  from  the  outside 
or  directly  from  the  schoolroom. 

The  boys'  closet,  wherever  located,  should  be  pro\dded 
with  a  urinal  as  well  as  seats.  This  in  its  simplest  form  is 
a  trough  constructed  across  one  end  of  the  outhouse  with 
sufficient  slope  to  carry  the  water  away  rapidly  either  to  the 
soil  or  into  the  cesspool.  The  trough  should  be  made  of  metal, 
cement,  or  wood  lined  with  copper  or  galvanized  iron. 

In  certain  sections  a  chemical  closet  is  being  used  which 
is  reported  as  giving  satisfaction.  Tliis  consists  of  an  all- 
metal  box  with  a  door  on  the  front,  and  a  seat  with  a  cover 
fitting  air-tight  on  top.  If  the  closet  is  used  in  a  room  inside 
the  school  building,  a  three-inch  pipe  connects  the  top  of  the 
box  with  a  chimney.  The  suction  in  the  chimney  creates  a 
draft  through  the  box  which  removes  from  it  all  gases  and 
odors.  A  metal  receptacle  is  placed  inside  of  the  box  to  hold 
the  excreta.  In  this  is  placed  two  to  six  inches  of  water  in 
which  are  dissolved  certain  chemicals  that  destroy  all  germs 
of  diseases  in  the  excreta. 

The  most  satisfactory  of  all  closets  is  the  sanitary  flush 
closet.    This  is  easily  possible  in  many  country  schools,  even 


RURAL   SCHOOL  SANITATION  37 1 

in  one-room  schools.  A  supply  of  water  with  the  necessary 
pressure  may  be  obtained  from  an  overhead  tank  filled  by  a 
common  force-pump,  or  from  the  pneumatic  tank  previously 
described. 

Sewage  Disposal. — The  great  difhculty  with  the  use  of 
the  water-flush  closet  is  the  disposal  of  the  sewage.  The  most 
satisfactory,  inexpensive  way  is  by  use  of  the  septic  tank 
and  a  subsurface  system  of  distribution  of  the  water.  In  its 
simplest  form  this  is  an  underground  tank  to  which  the  liquids 
from  the  closets  are  brought  and  in  which  they  are  retained 
for  from  twelve  to  twenty-four  hours  and  then  rapidly  dis- 
charged into  open  jointed  tiles  from  which  they  leak  out  into 
the  soil  to  disappear.  The  discharge  from  the  tank  is  regu- 
lated by  a  siphon.  This  intermittent  flow  from  the  tank 
into  the  soil  allows  the  air  to  enter  the  soil  while  the  tank  is 
filling  and  oxidize  the  organic  matter  contained  in  the  sewage, 
converting  it  into  harmless  mineral  forms  suitable  for  plant- 
food. 

A  better  form  of  tank  is  the  double  tank,  with  the  first 
chamber  to  retain  the  sohd  matter  and  scum  until  they  dis- 
solve, and  the  second  chamber  to  accumulate  the  liquids  and 
discharge  them  intermittently  by  means  of  a  siphon.  The 
solids  dissolve  rapidly  and  but  little  settlings  remain  in  the 
first  tank.  The  pipe  connecting  the  first  tank  with  the  second 
tank  is  arranged  so  that  the  first  tank  is  always  filled  to  a 
certain  depth  with  liquids  and  so  that  the  liquids  taken  out 
are  taken  from  midway  between  the  surface  and  bottom. 
Then  neither  the  scum  nor  settlings  are  disturbed. 

Satisfactory  tanks  may  be  constructed  of  cement  by  any 
farmer  or  carpenter  at  a  cost  varying  from  $25  to  $50.  Several 
patented  septic  tanks  are  on  the  market  and  may  be  purchased 
at  a  reasonable  cost. 

Conclusion. — Improved  rural  school  sanitation  is  impera- 
tive, not  only  for  the  sake  of  the  children  who  are  compelled 
by  law  to  attend  the  schools  for  several  of  the  most  plastic 
years  of  their  fives,  but  because  of  the  direct  and  indirect 


372  EDUCATIONAL   HYGIENE 

effects  on  rural  hygiene  in  general.  Progress  in  sanitation 
and  preventive  medicine  has  quite  largely  passed  by  the 
rural  portions  of  our  country,  and  the  public  school  is  the 
chief  instrument  for  catching  up  with  the  times.  Through 
Federal  dissemination  of  information,  through  State  aid  in 
money  and  expert  guidance,  and  through  teachers  and  county 
superintendents  better  educated  in  rural  hygiene,  we  may  ex- 
pect speedy  readjustments. 

The  following  statement  of  minimum  sanitary  essentials 
for  rural  schools  is  authoritative  and  very  important: 

MINIMUM    SANITARY    REQUIREMENTS    FOR    RURAL 
SCHOOLS  > 

It  is  the  desire  and  purpose  of  this  committee  to  help  establish 
a  standard  of  fundamental  health  essentials  in  the  rural  school  and  its 
material  equipment,  so  that  attainment  of  this  minimum  standard 
may  be  demanded  by  educational  authorities  and  by  public  opinion 
of  every  rural  school  throughout  the  country. 

Possession  of  the  minimum  sanitary  requirements  should  be 
absolutely  necessary  to  the  pride  and  self-respect  of  the  community, 
and  to  the  sanction  and  approval  of  county.  State,  and  other  super- 
vising and  interested  official  or  social  agencies. 

Neglect  of  anything  essential  for  health  in  construction,  equip- 
ment, and  care  of  the  rural  school  plant  is  at  least  an  educational  sin 
of  omission  and  may  reasonably  be  considered  a  social  and  civic  crime 
or  misdemeanor. 

The  country  school  should  be  as  sanitary  and  wholesome  in  all 
essential  particulars  as  the  best  home  in  the  community.  Further, 
it  should  be  pleasing  and  attractive  in  appearance,  in  furnishings,  and 
in  surroundings,  so  that  the  community  as  a  whole  may  be  proud  of 
it;  so  that  the  pupils  and  teacher  may  take  pleasure  in  attending 
school  and  in  caring  for  and  improving  it. 

'  Proposed  by  the  Joint  Committees  on  Health  Problems  in  Education  of 
the  National  Council  of  the  National  Education  Association  and  of  the  Ameri- 
can Medical  Association.  Pamphlet  published  by  the  American  Medical  As- 
sociation, Chicago.  See  also  Dresslar's  bulletin  (U.  S.  Bureau  of  Education) 
on  "Rural  Schoolhouses  and  Grounds"  and  Rapeer's  "  Standardization  of  the 
Rural  School  Plant"  in  School  and  Society  for  Feb.  15,  191 5,  and  his  survey 
of  "Rural  School  Hygiene"  in  the  Pennsylvania  "Rural  School  Report"  to 
the  State  Educational  Association,  1914. 


RURAL  SCHOOL  SANITATION  373 

I.    Location  and  Surroundings 

The  school  should  be  located  in  as  healthful  a  place  as  exists  in 
the  community. 

Noise  and  all  other  objectionable  factors  should  be  eliminated 
from  the  immediate  environment  of  the  rural  school. 

Accessibility. — Not  more  than  two  miles  from  the  most  distant 
home,  if  the  children  walk.  Not  more  than  six  miles  from  most  dis- 
tant home,  if  school  wagons  are  provided. 

Drainage. — School  ground  must  be  well  drained  and  as  dry  as 
possible.  If  natural  drainage  is  not  adequate,  artificial  subsoil  drain- 
age should  be  provided. 

Soil. — As  every  rural  school  ground  should  have  trees,  shrubs, 
and  a  real  garden  or  experimental  farm,  the  soil  of  the  school  grounds 
should  be  fertile  and  tillable.  Rock  and  clay  soil  should  always  be 
avoided.  If  the  soil  is  muddy  when  wet,  a  good  layer  of  sand  and  fine 
gravel  should  be  used  to  make  the  children's  playground  as  useful  as 
possible  in  all  kinds  of  weather. 

Size  of  School  Grounds. — For  the  schoolhouse  and  playground  at 
least  three  acres  are  required.^ 

Playground  is  not  a  luxury  but  a  necessity.  A  school  without  a 
playground  is  an  educational  deformity  and  presents  a  gross  injustice 
to  childhood. 

Arrangement  of  Grounds. — The  school  grounds  should  have  trees, 
plants,  and  shrubs  grouped  with  artistic  effect  but  without  interfering 
with  the  children's  playground. 

II.    Schoolhouse 

The  schoolhouse  should  be  made  as  nearly  fire-proof  as  possible. 
Doors  should  always  open  outward  and  the  main  door  should  have  a 
covered  entrance;  a  separate  fuel-room  should  be  provided,  also  separate 
cloak-rooms  for  boys  and  for  girls. 

A  basement  or  cellar,  if  provided,  should  be  well  ventilated  and 
absolutely  dry. 

The  one-teacher  country  school  should  contain,  in  addition  to  the 
classroom: 

(a)  A  small  entrance-hall,  not  less  than  6  by  8  feet. 

{b)  A  small  retiring-room,  not  less  than  8  by  10  feet,  to  be  used 
as  an  emergency-room  in  case  of  illness  or  accident,  for  a  teacher's 

1  If  the  rural  school  plant  includes  the  additional  features  (a  teacher's  home, 
a  garden,  and  an  experimental  farm),  which  are  already  in  some  progressive 
States  accepted  and  established  as  educational  essentials,  then  the  school 
grounds  should  contain  eight  to  ten  acres. 


374  EDUCATIONAL  HYGIENE 

conference-room,  for  school  library,  and  for  health  inspection,  a  fea- 
ture now  being  added  to  the  work  of  the  rural  school. 

(c)  A  small  room,  not  less  than  8  by  lo  feet,  for  a  workshop, 
for  instruction  in  cooking,  and  for  the  preparation  of  refreshments 
when  the  school  is  used,  as  it  should  be,  for  social  purposes. 

Classroom  should  not  be  less  than  30  feet  long,  20  feet  wide,  and 
12  feet  high.  This  will  provide  space  enough  for  a  maximum  of 
thirty  pupils. 

III.    Ventilation  and  Heating 

The  schoolroom  should  always  receive  fresh  air  coming  directly 
from  out  of  doors  in  one  of  the  following  arrangements: 

(a)  Through  wide-open  windows  in  mild  weather. 

(b)  Through  window-board  ventilators  under  all  other  con- 
ditions, except  when,  with  furnace  or  jacketed  stove,  special  and  ade- 
quate inlets  and  exits  for  air  are  provided. 

Heating. — Unless  furnace  or  some  other  basement  system  of  heat- 
ing is  installed,  at  least  a  properly  jacketed  stove  is  required.  (No  un- 
jacketed  stove  should  be  tolerated  in  any  school.) 

The  jacketed  stove  should  have  a  direct  fresh-air  inlet  about  12 
inches  square,  opening  through  the  wall  of  the  schoolhouse  into  the 
jacket  against  the  middle  or  hottest  part  of  the  stove. 

The  exit  for  foul  air  should  be  through  an  opening  at  least  16 
inches  square  on  the  wall  near  the  floor,  on  the  same  side  of  the  room 
as  the  stove  is  located. 

A  fireplace  with  flue  adjoining  the  stove  chimney  makes  a  good 
exit  for  bad  air.* 

Temperature. — Every  school  should  have  a  thermometer,  and  the 
temperature  in  cold  weather  should  be  kept  between  66  and  68  de- 
grees Fahrenheit. 

IV.     Lighting 

The  schoolroom  should  receive  an  abundance  of  light,  sufficient 
for  darkest  days,  with  all  parts  of  the  room  adequately  illuminated. 

The  area  of  glass  in  windows  should  be  from  one-fifth  to  one- 
fourth  of  the  floor  area. 

The  best  arrangement,  according  to  present  ideas,  is  to  have  the 
light  come  only  from  the  left  side  of  the  pupils  and  from  the  long  wall 
of  the  classroom.      Windows  may  be  allowed  on  rear  as  well  as  on  the 

'  The  following  arrangement  for  ventilating-flue  is  required  in  one  Western 
State:  A  circular  sheet -steel  smoke-flue,  passing  up  in  centre  of  ventilating 
shaft  (foul -air  exit),  20  inches  square  in  the  clear. 


RURAL   SCHOOL   SANITATION  375 

left  side.  High  windows  not  less  than  seven  feet  from  the  floor  may 
be  permitted  on  the  right  side  as  an  aid  to  cross-ventilation,  but  not 
for  lighting. 

There  should  be  no  trees  or  shrubbery  near  the  schoolhouse  which 
will  interfere  with  the  lighting  of  the  classroom. 

The  school  building  should  so  face  with  reference  to  the  windows 
that  the  schoolroom  will  receive  the  direct  sunlight  at  some  time  dur- 
ing the  day. 

Shades  should  be  provided  at  tops  and  bottoms  of  windows,  with 
the  dark  shades  at  top,  so  that  light  may  be  properly  controlled  on 
bright  days. 

Schoolroom  Colors. — The  best  colors  for  the  schoolroom  in  relation 
to  lighting  are: 

Ceiling — white  and  light  cream. 

Walls — light  gray,  green. 

Blackboards — black, 

V.     Cleanliness 

The  schoolhouse  and  surroundings  should  be  kept  as  clean  as  a 
good  housekeeper  keeps  her  home. 

(o)  No  dry  sweeping  or  dusting  should  be  allowed. 

{b)  Floors  and  furniture  should  be  cleaned  with  damp  sweepers 
and  oily  cloths.^ 

(c)   Scrubbing  and  airing  are  better  than  any  form  of  fumigation. 

VI.     Drinking  Water 

Drinking  water  should  be  available  for  every  pupil  at  any  time  of 
day  which  does  not  interfere  with  the  school  programme. 

Every  rural  school  should  have  a  sanitary  drinking-fountain 
located  just  inside  or  outside  the  schoolhouse  entrance. 

Drinking  water  should  come  from  a  safe  source.  Its  purity  should 
be  certified  by  an  examination  by  the  State  board  of  health  or  by  some 
other  equally  reliable  authority. 

A  common  drinking-cup  is  always  dangerous  and  should  never  be 
tolerated. 

Individual  drinking-cups  are  theoretically,  and  in  some  conditions, 
all  right,  but  practical  experience  has  proven  that  in  schools  individual 
cups,  to  be  used  more  than  once,  are  unsatisfactory  and  unhygienic. 
Therefore  they  are  not  to  be  advocated  nor  approved  for  any  school. 

^  Sweeping  compounds  in  moisture-proof  containers  may  be  obtained  in  the 
market. 


376  EDUCATIONAL   HYGIENE 

Sufficient  pressure  for  running  water  for  drinking-fountain  or 
other  uses  in  the  rural  school  may  always  be  provided  from  any  source 
without  excessive  expense  by  a  storage-tank  or  by  pressure-tank  with 
force-pump. 

VII.     Water  for  Washing 

Children  in  all  schools  should  have  facilities  for  washing  hands 
available  at  least: 

(a)  Always  after  the  use  of  the  toilet. 

(/;)   Always  before  eating. 

{c)  Frequently  after  playing  outdoors,  writing  on  blackboard 
or  doing  other  forms  of  hand-work  connected  with  the  school. 

Individual  clean  towels  should  always  be  used. 

Paper  towels  are  the  cheapest  and  most  practicable. 

The  common  towel  is  as  dangerous  to  health  as  the  common 
drinking-cup. 

VIII.     Furniture 

School  seats  and  desks  should  be  hygienic  in  type  and  adjusted  to 
the  size  and  needs  of  growing  children.  Seats  and  desks  should  be 
individual — separate — adjustable— clean. 

Books  and  other  materials  of  instruction  should  not  only  be  sani- 
tary but  attractive  enough  to  stimulate  a  wholesome  response  from 
the  pupils. 

IX.     Toilets  and  Privies 

Toilets  and  privies  should  be  sanitary  in  location,  construction, 
and  in  maintenance. 

(a)  If  water-carriage  system  for  sewage  is  available,  separate 
toilets  for  boys  and  girls  should  be  located  in  the  schoolhouse,  with 
separate  entrances  on  different  sides  or  corners  of  the  school  building. 

(b)  If  there  is  no  water-carriage  system,  separate  privies  should  be 
located  at  least  fifty  feet  in  the  difTerent  directions  from  the  school- 
house,  with  the  entrances  well  screened. 

((•)  The  privy  should  be  rainproof,  well  ventilated,  and  one  of  the 
following  types: 

(i)   Dry  earth  closet. 

(2)  Septic-tank  container. 

(3)  With  a  water-tight  vault  or  box. 

All  containers  of  excreta  should  be  water-tight,  thoroughly  screened 
against  insects,  and  easily  emptied  and  cleaned  at  frequent  intervals. 


RURAL   SCHOOL   SANITATION  377 

No  cesspool  should  be  used  unless  it  is  water-tight  and  easily 
emptied  and  cleaned. 

All  excreta  should  be  either  burned,  buried,  treated  by  subsoil 
drainage,  reduced  by  septic-tank  treatment,  or  properly  distributed 
on  tilled  land  as  fertilizer. 

X.  All  Schoolhouses  and  Privies  Should  be  Thoroughly  and 
Effectively  Screened  against  Flies  and  Mosquitoes 

XI.  Schoolhouses  and  Outhouses  Should  be  Absolutely  Free 

FROM  All  Defacing  and  Obscene  Marks 

XII.  Buildings   Should  be  Kept  in   Good  Repair  and  with 

Whole  Windows 


STANDARDS 


Provision  and  equipment  of  adequate  school  plant  depends  on  in- 
telligence, interest,  pride,  and  financial  ability  of  community. 

Maintenance  of  a  clean  and  sanitary  school  plant  depends  on 
efificient  housekeeping,  and  on  interest  and  willing  co-operation  of 
pupils. 

No  community  should  be  satisfied  by  the  minimum  requirements 
indicated  in  the  foregoing,  but  every  country  school  should  be  so  at- 
tractive and  well  equipped  as  to  minister  with  some  abundance  of 
satisfaction  to  the  physical,  mental,  aesthetic,  social,  and  moral  well- 
being  of  those  who  provide  it,  who  own  it,  who  use  it,  and  who  enjoy  it. 

Present  Conditions 

Among  the  reasons  which  explain  the  present  deplorable  con- 
ditions of  rural  schoolhouses,  the  following  are  prominent: 

(a)  Low  architectural  and  sanitary  standards  in  rural  regions 
generally  throughout  the  country. 

(b)  Ignorance  regarding  the  physical,  mental,  social,  and  moral 
effects  of  unattractive  and  unsanitary  school  buildings  on  the  children 
and  on  the  community  as  a  whole. 

(c)  False  economy  expressed  by  local  school  boards  in  failure  to 
vote  enough  money  to  build  and  maintain  suitable  school  buildings. 

(d)  Lack  of  supervision  or  assistance  by  the  State,  which  is  usually 
necessary  to  maintain  desirable  standards. 


378  EDUCATIONAL  HYGIENE 


Improvement 

How  shall  the  rural  schools  throughout  this  country  be  improved 
up  to  a  reasonably  satisfactory  standard? 

I.  By  a  popular  campaign  of  education  regarding  the  conditions 
desirable  and  possible  in  the  country  school.  Such  a  campaign  would 
profitably  include  many  or  most  of  the  following: 

(a)  The  United  States  Bureau  of  Education  and  State  depart- 
ments of  education  should  furnish  plans  and  instructions  for  construc- 
tion and  equipment  of  rural  school  buildings. 

The  United  States  Bureau  of  Education  in  Washington  is  already 
supplying,  on  request,  valuable  help  of  this  kind,  and  a  few  State 
departments  of  education  are  demonstrating  what  may  be  done  by 
supervision  and  support  which  aids  without  controlling. 

(h)  State  departments  of  education  should  supply  supervision  of 
rural  schools  and  should  have  power: 

(i)  To  condemn  insanitary  and  wholly  unsuitable  buildings. 

(2)  To  give  State  aid  to  rural  schools  when  the  local  authorities 
fulfil  certain  desirable  and  reasonable  conditions. 

(c)  Ideas  and  standards  of  school  sanitation  should  be  inculcated 
in  minds  of  local  school  patrons  and  school  authorities  who  control 
school  funds  and  who  administer  the  affairs  of  the  schools.  Public 
lectures  on  health  topics  should  be  provided  in  the  schoolhouse  and 
elsewhere. 

(d)  EfTective  school  health  courses  should  be  introduced  in  normal 
schools  and  teachers'  institutes. 

Better  education  of  rural  school-teachers,  county  superintendents, 
and  rural  school  supervisors  in  the  principles  and  practise  of  school 
hygiene  and  sanitation  should  be  assured. 

(e)  Interest  in  and  enthusiasm  for  the  improvement  and  care  of 
all  features  of  the  school  and  its  surroundings  which  affect  health  and 
happiness  should  be  inspired  in  the  minds  of  rural  school  pupils. 

Organizations  such  as  "Pupils'  Board  of  Health,"  "Civic  Leagues," 
or  "Health  Militias"  may  profitably  be  formed  among  pupils. 

(/)  Organizations  like  "The  Granges,"  Women's  Clubs,  County 
Medical  Societies,  and  other  groups  so  situated  that  they  may  further 
the  cause  of  health  and  efiiciency,  should  co-operate  with  the  rural 
school. 

(g)  Attractive  but  reliable  health  information  should  be  furnished 
abundantly  by  the  public  press. 

II.  Emulation  and  competition  should  be  recognized  and  re- 
warded in  ways  that  will  promote  wholesomely  and  progressively  the 
welfare  of  the  community  as  a  whole. 


RURAL    SCHOOL    SANITATION  379 


TEN  SANITARY  COMMANDMENTS  FOR  RURAL  SCHOOLS 

In  every  school  which  may  be  considered  passably  sanitary  the 
following  conditions  shall  obtain: 

1.  Heating  by  at  least  a  properly  jacketed  stove.     (No  unjacketed 
stove  to  be  allowed.) 

Ventilation  by  direct  outdoor-air  inlets  and  by  adequate  and  di- 
rect foul-air  outlets. 

2.  Lighting  from  left  side  of  room  (or  from  left  and  rear)  through 
window  space  at  least  one-fifth  of  floor  space  in  area. 

3.  Cleanliness  of  school  as  good  as  in  the  home  of  a  careful  house- 
keeper. 

4.  Furniture  sanitary  in  kind,  and  easily  and  frequently  cleaned. 
Seats  and  desks  adjustable  and  hygienic  in  type. 

5.  Drinking  water  from   a  pure  source  provided  by  a  sanitary 
drinking-fountain. 

6.  Facilities  for  washing  hands,  and  individual  towels. 

7.  Toilets  and  privies  sanitary  in  type  and  in  care  (with  no  cess- 
pools unless  water-tight)  and  no  neglected  privy  boxes  or  vaults. 

8.  Flies  and  mosquitoes  excluded  by  thorough  screening  of  school- 
house  and  toilets. 

9.  Obscene  and  defacing  marks  absolutely    absent  from  school- 
house  and  privies. 

10.  Playground  of  adequate  size  for  every  rural  school. 


III.     PHYSICAL   EDUCATION 

CHAPTER   XXI 
PLAY  AND  PLAYGROUNDS  IN  CITIES 

The  Problem. — Every  one  is  familiar  with  the  fact  that 
the  modern  city  has  greatly  restricted  the  natural  play  op- 
portunities of  the  children.  The  recognition  of  the  need  to 
restore  opportunities  to  city  children  by  providing  municipal 
playgrounds  has  been  one  phase  of  a  more  general  recognition 
of  the  nature  and  significance  of  play  itself  and  its  relation 
to  child  welfare  generally.  It  is  the  purpose  of  this  chapter 
to  suggest  how  play  is  an  essential  in  child  development  and 
education,  and  how  it  may  be  utilized. 

Common  Misconceptions  Concerning  Play. — At  the  out- 
set of  this  discussion  of  play  and  playgrounds  let  us  attempt 
to  clear  away  some  common  misconceptions  concerning  play. 

(i)  Contrary  to  the  common  idea  of  play,  play  is  serious. 
Children  often  make  their  games  the  object  of  their  prayers. 
And  not  children  only,  for  young  men  have  done  the  same, 
in  manner  hardly  different  from  that  of  Washington  kneeling 
at  Valley  Forge.  Players,  both  children  and  adults,  come  at 
their  play  frequently  in  all  seriousness. 

But  play  is  regarded  seriously  also  by  those  who  are  not 
the  players,  as  every  observer  of  the  followers  of  a  favorite 
team  can  testify. 

Plato  and  Froebel,  as  we  all  know,  regarded  play  as 
serious.  Guths  Muths,  the  father  of  play  in  Germany,  said, 
"Pro  patria  est,  cum  ludere  videmur,"  and  the  regeneration 
of  Germany  is  recognized  as  having  been  influenced  greatly 
by  the  revival  of  play  under  Guths  Muths  and  Jahn.     Pro- 

380 


PLAY  AND   PLAYGROUNDS   LN   CITIES  381 

fessor  Dewey  says:  "Because  amusement  is  contrasted  with 
serious  things,  we  have  forgotten  that  the  function  of  recrea- 
tion, of  the  spending  of  the  hours  of  leisure,  is  one  of  the  most 
serious  questions,  intellectually  and  morally,  of  life.''^ 

Play  contributes  to  human  progress.  Biologically  consid- 
ered, play  has  doubtless  been  the  largest  element  in  human 
advancement.  Acting  like  an  instinct,  it  has  conserved  the 
essential  powers  of  the  race  and  impelled  activities  to  more 
complicated  and  efficient  forms.  On  the  other  hand,  play  has 
doubtless  contributed  to  decadence  when  prostituted  into 
evil  channels.  Professor  O'Shea  has  cited  the  effect  of  un- 
desirable forms  of  play  on  the  decay  of  nations,  and  warns  us 
that,  when  the  absorbing  interests  of  youth  follow  undesirable 
forms  or  become  excessive,  decadence  begins.  There  is  no 
greater  national  concern  than  what  and  how  the  people  play. 

In  this  connection  it  is  of  interest  to  note  the  path  of  prog- 
ress of  play  as  it  has  expressed  the  tribal  or  national  con- 
sciousness. Many  games  and  dances,  as  is  well  known, 
originated  in  some  religious  ceremony.  Some  of  the  festival 
customs  of  to-day,  for  example,  have  come  down  through  the 
Roman  ferice.  the  Saturnalia,  and  the  barbaric  festivals  of 
the  Middle  Ages.  Gradually  there  was  lost  the  ceremonial 
significance.  Festivals  and  games  became  barbaric  as  in  the 
horrible  ludi  of  the  Colosseum,  the  barbarism  persisting  even 
now  in  some  sections  of  the  world  in  bull-fights,  prize-fighting, 
or  demoralised  football.  But,  on  the  whole,  the  heroic  games 
of  to-day  are,  as  Beulah  Kennard  has  said,  civilized.  Even 
boxing,  according  to  Maeterlinck,  has  become  the  "acme  of 
convention."  No  one  in  decent  circles  could  remain  an 
acceptable  boxer  who  did  not  adhere  most  rigidly  to  the 
recognized  social  standards  of  the  game.  Our  national  game 
of  baseball,  the  most  striking  national  play  interest  of  the 
world  of  to-day,  has  in  the  great  leagues  become  in  standards 
fully  civilized  and  holds  unprecedented  confidence  of  the 
public  for  honesty  and  good  sportsmanship. 

1  "Play,"  Monroe's  "Cyclopedia  of  Education." 


382  EDUCATIONAL  HYGIENE 

(2)  Contrary  to  the  common  idea  also,  play  is  concerned 
with  result  and  not  with  activity  only.  In  such  play  as 
nutting,  hunting,  fishing,  and  construction  the  player  is  often 
greatly  concerned  with  the  product  or  result  of  the  activity. 
Likewise  the  increased  skill  of  the  player,  or  the  honor  of 
victory,  or  the  prestige  of  success,  is  scarcely  less  a  real  ob- 
jective result  or  less  an  ulterior  purpose  than  is  the  success  of 
the  man  or  woman  in  public  life. 

(3)  Play  is  not  always  pursued  just  for  the  fun  of  it;  that 
is,  play  is  not  always  and  continuously  pleasurable.  Play  is 
often  painful.  Boxing,  wrestling,  rowing,  racing,  football, 
and  nearly  all  hardy  games  are  often  accompanied  by  pain. 
It  is  significant  that  our  word  "agony"  comes  from  the  Greek 
word  a^ycovia^  the  word  used  to  designate  the  public  games 
and  contests  of  the  Greeks.  No  one  who  has  seen  the  models 
of  the  faces  of  athletes  by  Doctor  R.  Tait  McKenzie  can 
fail  to  get  a  suggestion  of  the  agony  which  a  runner  often  en- 
dures in  a  race.  Play  courts  the  difficult  and  the  heroic,  and 
not  necessarily  the  soft  and  the  easy. 

(4)  Contrary  to  the  idea  of  many,  play  can  he  taught. 
While  there  are  many  forms  of  play  that  are  pursued  as 
instinctively  as  birds  build  nests,  yet  the  more  complicated 
forms  of  plays  or  games  have  to  be  taught.  According  to 
Culin  and  E.  B.  Taylor,  probably  no  games  are  played  to-day 
the  rudiments  of  which,  at  least,  have  not  been  taught  from 
generation  to  generation  ever  since  the  building  of  the  Eg>'p- 
tian  pyramids  or  earlier.  It  is  by  the  teaching  of  play  only 
that  play  traditions  have  endured,  or  games  developed  into 
their  present  form.  It  is  evident  that  without  teaching  the 
boys  of  to-day  would  be  no  more  likely  to  play  the  American 
game  of  baseball  than  were  the  children  in  the  streets  of 
Beni  Hassan  four  thousand  years  ago.  The  "teaching  of 
play,"  in  the  modern  sense,  is  at  most  only  changing  the 
teacher  from  a  child  to  an  adult,  from  a  novice  to  an  expert. 

From  the  above  it  will  be  seen  that  characteristics  com- 
monly supposed  to  belong  to  work  only,  belong  also  to  play. 


m^ 


PLAY  AND   PLAYGROUNDS   IN   CITLES  383 

Many  excellent  educators  fear  that  the  emphasis  upon  play 
may  weaken  the  capacity  of  the  child  for  work,  and  make  it 
less  possible  to  harness  activity  and  direct  it  toward  the  ac- 
complishment of  definite  ends.  This  is  a  groundless  fear,  be- 
cause in  many  cases  play  lends  itself  to  definite  ends  much 
better  than  work.  It  is  almost  hopeless  to  try  to  discover 
any  exact  differentiation  of  play  and  work,  because  the  dis- 
tinction lies  so  often  in  the  subjective  attitude  of  the  indi- 
vidual alone,  and  the  very  same  activity  becomes  play  or 
work  by  some  subtle  shift  of  the  point  of  view.  However, 
it  may  be  said  that  the  more  work  takes  on  the  character- 
istics of  play  the  better.  Brinton  has  well  said :  ''The  measure 
of  the  value  of  play  is  the  amount  of  work  there  is  in  it;  and 
the  measure  of  the  value  of  work  is  the  amount  of  play  there 
is  in  it."^ 

Why  Children  Play. — Without  entering  at  length  into  a 
discussion  of  the  nature  of  play,  it  may  be  briefly  stated  that 
all  plays  and  games  are  imitations  or  repetitions  of  types  of 
activity  that  have  been  followed  in  the  development  of  the 
race.  Further,  it  may  be  stated  that  the  play  of  animals 
varies  according  to  the  structure  or  physical  characteristics 
of  the  animals.  The  play  of  puppies  and  the  play  of  kittens, 
for  example,  differs  as  the  structure  of  their  bodies  and  nervous 
systems  differ.  Dogs  in  their  play  run,  chase,  and  tear,  or 
cling  with  their  teeth  more  than  cats.  Cats  in  their  play 
stalk,  scratch,  and  strike  with  their  paws  more  than  dogs. 
These  differences  coincide  with  the  differences  both  as  to  the 
structure  and  the  experiences  of  the  animals.  Now,  some 
biologists  tell  us  that  the  structure  of  the  cat's  paw  and  that 
of  the  dog  have  come  about  in  each  case  through  the  differ- 
entiation of  activities  pursued  by  the  cats  and  the  dogs  of 
previous  generations.     Function,  they  say,  determined  struc- 

'  For  further  discussion  of  play  and  work  the  reader  is  referred  to  Carr's 
"The  Survival  Values  of  Play,"  University  of  Colorado  Studies;  Dewey's 
"Play,"  in  Monroe's  "Cyclopedia  of  Education";  the  author's  "Play  versus 
Work  in  Education,"  Proceedings  of  the  National  Congress  of  School  Hygiene, 
J913;  and  Curtis's  "Play  and  Recreation"  and  "Education  Through  Play." 


384  EDUCATIONAL  HYGIENE 

ture.  To  illustrate:  the  ameba  has  four  functions,  namely, 
nutrition,  locomotion,  sensation,  reproduction.  Yet  it  has 
no  special  organs.  It  eats,  digests,  and  assimilates  food, 
but  it  has  no  organs  of  locomotion;  it  responds  to  stimuli  but 
it  has  no  nervous  system;  it  reproduces  its  kind  but  it  has  no 
organs  of  reproduction.  As  we  go  up  the  scale  of  life  we  find 
these  same  four  functions  and  no  more.  But  there  is  a 
tendency  in  nature  always  to  do  things  better  and  better, 
and  special  organs  gradually  developed.  These  biologists, 
therefore,  formulated  a  law,  namely,  that  function  determined 
structure,  that  doing  fashioned  the  organ  that  does  the 
doing.  For  example,  so  they  believe,  the  structure  of  the 
human  hand  and  the  structure  of  that  part  of  the  nervous 
system  controlling  it  differ  from  the  structure  of  the  hand 
and  of  the  corresponding  part  of  the  nervous  system  of  the 
ape  because  of  what  the  hand  of  man  has  done.  The  increased 
function  of  the  human  hand  over  that  of  the  ape  has  deter- 
mined its  distinctive  structure. 

Thus  the  various  and  marvellously  complex  organs  of  the 
human  body,  according  to  this  view,  developed  through  dif- 
ferentiation of  function.  The  law  holds  good  also,  they 
thought,  when  function  diminished.  Structure  then  deteri- 
orated, as  illustrated  in  the  vestigial  organs  of  the  human 
body  such  as  the  notorious  and  nefarious  appendix  and  the 
muscles  that  once  moved  the  ears  or  nose. 

There  are  other  biologists,  however,  who  believe  that 
structure  preceded  rather  than  followed  function.  Accord- 
ing to  these  (and  they  seem  now  to  be  having  their  inning) 
structure  was  determined  in  the  germ  plasm  and  not  at  all 
directly  through  exercise  or  experience.  Their  proposition  is 
the  converse  of  the  other,  namely,  structure  determined 
function. 

Now,  both  these  propositions  are  of  great  interest  to  the 
student  of  play,  for  each  suggests  one  and  the  same  cor- 
ollary, namely,  structure  demands  function.  It  does  not 
matter  materially  to  us  whether  nature  first  created  a  struc- 


PLAY   AND   PLAYGROUNDS   IN   CITIES  385 

ture  and  then  found  a  use  for  it  or  first  found  a  use  and  then 
created  a  structure  to  meet  it;  whether  the  ancestors  of  the 
wart-hog,  for  example,  developed  callosities  on'their  knees  by 
kneeling  as  they  rooted  for  a  living  or  took  that  advantageous 
position  because  they  were  born  with  callosities  on  their 
knees.  In  either  case  we  come  face  to  face  with  the  fact 
that  when  in  the  course  of  generations  structure  has  been  de- 
veloped, or  mutations  and  variations  in  structure  have  by 
selection  come  about,  in  each  succeeding  generation  this 
inherited  structure  demands  its  appropriate  function.  During 
the  long  process  of  evolution  the  great  complexity  and  inter- 
relations of  the  members  and  organs  of  the  human  body  and 
nervous  system  have  been  developed  through  function  or 
through  variation  and  selection  as  the  case  may  be,  and  as 
each  organ  evolves  through  the  various  stages  of  immaturity 
toward  maturity  there  is  at  every  phase  of  its  development, 
under  the  physiological  condition  of  good  nutrition  and  ap- 
propriate stimuli,  an  impulse,  a  hunger,  a  passion,  for  the 
same  general  kind  of  activity  or  function  that  determined,  or 
accompanied,  the  corresponding  structure  in  the  species. 

There  are  infinite  manifestations  of  this  craving  for  func- 
tion. When  a  blind  child  stands  before  the  window  and 
flickers  his  open  fingers  before  his  face,  letting  now  the  light, 
now  the  shade  fall  upon  his  sightless  eyes,  he  is  trying  to 
satisfy  the  craving  of  the  optic  nerve  which  has  been  cheated 
of  its  appropriate  function.  When  the  idiotic  child  sits 
through  long  hours,  with  arms  folded  upon  a  bench  before 
him,  and  beats  his  head  upon  his  arms  with  insatiable  zeal 
until  great  calli  are  formed  upon  his  wrists  and  forehead,  he 
does  it  in  response  to  this  craving  for  function.  When  the 
infant  smiles  into  its  mother's  face,  or  grasps  with  its  chubby 
hand  and  kicks,  or  coos,  or  strives  to  lift  itself  for  freer 
vision  of  light  or  shadow  or  color  or  object,  or  listens  for  a 
sound,  or  creeps,  or  climbs,  or  handles,  or  tastes,  the  same 
law  is  manifest.  When  the  child  responds  to  the  awakening 
power  of  speech,  or  of  memory,  or  of  strength  of  limbs,  or  of 


386  EDUCATIONAL  HYGIENE 

appreciation  of  companionship  or  of  social  relations,  or  of 
reasoning,  or  of  expression  in  different  forms,  or  of  leader- 
ship, or  of  organization,  again  we  see  structure  demanding 
function.  When  a  lad  of  the  streets  snatches  and  runs  in  the 
hope  of  being  chased ;  when  he  stones  cars  or  windows  or  pries 
open  a  door  in  the  freight-car;  when  he  pilfers  trinkets  and 
stores  them  in  a  rendezvous,  or,  inspired  by  a  nickelodeon, 
breaks  and  enters  a  store  for  mischief;  when  he  joins  a  gang; 
when  he  steals  lumber  and  builds  a  hut  and  plays  cards  and 
gambles  there  with  the  gang,  the  law  of  structure  and  func- 
tion still  holds.  When  the  "spirit  of  youth"  seeks  the  "city 
streets,"  or  a  youth  the  company  of  a  maiden,  or  a  young  man 
the  warmth  and  brilliance  of  the  saloon,  or  the  colored  lights 
of  the  city  where  he  would  not  be  seen,  here  also,  in  its  last 
analysis,  is  a  response  to  this  same  deep-seated  craving  for 
function.  When  a  mature  man  or  woman  strives  for  some 
desired  achievement  in  society,  politics,  literature,  art,  or 
religion,  or  seeks  for  personal  power  or  wealth  or  fame,  the 
same  law  holds.  Play  is,  as  James  said  of  instinct,  the  cor- 
relative of  structure,  it  is  that  for  which  man  is  structurally 
predisposed.  To  our  forefathers  it  was  "original  sin."  To 
us  it  has  as  good  a  right  to  be  "original  virtue," 

The  educational  significance  of  this  is  apparent.  If  the 
play  interests  have  their  genesis  in  structure  and  if,  in  the 
case  of  the  young,  the  development  of  structure  or  organ 
depends  upon  its  receiving  appropriate  exercise,  especially 
during  the  period  of  growth,  as  is  now  generally  believed, 
the  educational  value  of  play  in  conserving  and  developing 
hereditary  powers  is  apparent.  One  need  not  say  with  Groos 
that  the  young  play  in  order  to  prepare  for  future  serious  oc- 
cupations, or  with  Hall  that  the  young  play  in  response  to 
inherited  memory  of  past  experiences  of  the  race.  One  may 
rather  say  that  play  is  the  normal  functioning  of  structure 
in  accord  with  its  own  peculiar  nature  and  needs.  Play  is  of 
the  present  rather  than  of  the  past  or  of  the  future.  Its 
existence  may  be  explained  by  the  past,  its  nature  may  be  a 


PLAY   AND   PLAYGROUNDS   IN   CITIES  387 

prophecy  of  the  future;  but  play  is  essentially  a  manifestation 
of  the  present  life  and  present  nature  and  present  needs  of 
the  organism.  Yet  play  does  educate,  does  prepare  for  the 
future,  for  the  mature  man  has  no  powers  or  interests  or  oc- 
cupations that  are  not  based  upon  past  powers  or  interests 
or  occupations  of  the  race  and  that  do  not  in  the  fulness  of 
time  appear  in  prototype  in  the  plays  and  games  of  child- 
hood or  youth.  So  far  as  education  is  concerned  with  the 
development  of  right  interests  and  powers,  play  is  the  line  of 
least  resistance,  least  fatigue,  greatest  plasticity,  and  greatest 
interest  and  intensity.^  So  far  as  these  interests  and  powers 
can  serve  social  ends,  play,  not  work,  remains  logically  and 
naturally  the  most  efficient  means  of  education.^ 

Play  and  Health. — The  relation  of  play  to  health,  there- 
fore, is  obvious.  From  ameba  to  man  the  essential  conditions 
to  life  and  health  have  been  few  and  plain.  Through  all  the 
ages  of  that  slow  ascent,  but  with  varying  emphasis,  there 
have  been  food,  air,  sunshine,  exercise.  Upon  the  supply  of 
these  in  proper  kind  and  amount  depends  the  health  of  ameba, 
worm,  fish,  bird,  dog,  or  man. 

Omitting  the  first  of  these  for  obvious  reasons,  let  us  con- 
sider the  importance  of  each  of  the  others  in  child  hygiene 
and  the  ofhce  of  the  playground  in  supplying  them. 

Air. — The  playground  is  the  only  place  where  a  school- 
child  gets  air  in  the  proper  amount  and  kind,  the  only  place 
where  he  obtains  full  and  complete  aeration  of  the  blood. 
A  despicable  fraction  of  schoolrooms  have  standard  ventilat- 
ing apparatus,  and  the  rooms  that  have  do  not  always  ade- 
quately benefit  thereby.  I  have  personally  tested  a  score  of 
schoolrooms  almost  under  the  shadow  of  the  capitol  of  a 
State  that  has  the  best  of  existing  laws,  and  found  the  supply 
of  air  to  equal  the  standard  in  only  two  of  the  rooms,  and  in 
some  it  fell  to  less  than  one-fourth  of  that  amount. 

But  even  could  ventilation  be  perfect  in  a  schoolroom, 

'  See  Carr's  "  Survival  Values  of  Play,"  University  of  Colorado  Studies. 
-See  also  "Games,"  Monroe's  "Cyclopedia  of  Education." 


388  EDUCATIONAL  HYGIENE 

there  would  not  be  the  same  aeration  of  the  blood  in  a  seated 
studying  child  as  in  a  child  on  the  playground.  There 
must  be  the  exhilaration  of  joyous  exercise,  the  strengthened 
pulse,  the  quickened,  deepened  breathing,  the  full  chest  of 
sustained  effort,  that  drives  the  air  to  the  very  apexes  of  the 
lungs,  to  meet  the  needs  of  the  growing  child.  The  school- 
room may  be  made  less  and  less  objectionable,  but  so  long  as 
it  remains  a  schoolroom  it  cannot  escape  the  imperative  need 
of  the  playground  as  a  factor  in  school  hygiene. 

As  is  well  known,  it  is  not  only  the  lack  of  oxygen  but 
also  the  presence  of  organic  poison  in  exhaled  air  that  makes 
ventilation  so  important.  It  is  a  fact  noted  by  biologists 
that  all  animal  life  excretes  a  poison  destructive  to  itself. 
This  is  as  true  of  the  single-celled  animal  as  of  higher  life. 
Bacteria  may  thrive  luxuriantly  for  a  time  in  culture  media, 
but  if  they  are  not  transferred  to  fresh  culture  media  they 
pass  into  a  period  of  lessened  activity  and  finally  die  poisoned 
by  their  own  excretions.  A  child's  body  is  an  accumulation 
of  a  vast  number  of  cells,  each  of  which  by  its  very  functional 
activity  likewise  excretes  products  so  poisonous  to  itself  and 
the  system  generally  that  accumulation  beyond  a  certain 
limit  results  in  death. 

Now,  nature  has  gradually  placed  more  and  more  emphasis 
upon  this  cleansing  process.  If  you  trace  the  evolution  of  the 
vital  organs  from  the  single  cell  to  man,  you  will  find  a  general 
increase  in  the  number  of  the  excretory  organs.  The  newer 
organs  have  developed  as  supplementary  to  the  older,  and  all 
together  they  form  a  co-operative  system,  a  weakness  in  any 
part  of  which  places  an  added  burden  on  the  rest.  Nature 
here  gives  us  no  uncertain  hint  as  to  the  needs  of  the  child. 
Playground  activities  not  only  purify  the  blood  through  the 
increased  activity  of  the  lungs  in  the  pure  air  out-of-doors,  as 
the  activities  of  the  school  cannot  do,  but  also  stimulate  the 
healthful  activity  of  all  the  excretory  organs,  preserving  a 
well-balanced  system.  The  most  recent  ventilation  hypoth- 
esis, that  not  the  composition  but  the  condition  of  the  air 


PLAY  AND   PLAYGROUNDS  IN  CITIES  389 

is  the  important  feature,  strongly  reinforces  the  need  for 
outdoor  playgrounds,  for  here  change,  temperature,  humidity, 
and  freedom  from  dust  are  generally  superior. 

Sunshine. — "Where  the  sun  does  not  go,  the  doctor  does," 
is  an  Italian  proverb  quoted  by  Koetelmann.  Try  as  we  may, 
we  cannot  get  the  sun  sufficiently  into  all  our  schoolrooms, 
and  if  we  could  we  would  shut  it  out  again  as  soon  as  we  let 
the  children  in  to  study,  because,  we  say,  it  hurts  their  eyes. 

Where,  then,  shall  the  children  bathe  in  the  sunshine  as 
they  should  but  on  the  playground?  We  do  well  to  debar 
contagious  diseases  from  the  schools,  but  let  myriads  of 
bacilli  fly  over  our  children's  clothing  and  the  most  malig- 
nant will  in  a  short  time,  in  the  joy  and  the  sunshine  of  the 
playground,  perish.  Few  disease-germs  have  been  discovered 
that  can  survive  even  for  one  hour  the  streaming  sun  on  the 
face  of  a  laughing  child. 

You  remember  the  experiment  with  the  tadpoles.  They 
were  placed  away  from  the  sunlight  for  thirty  days  and  during 
all  that  time  ceased  to  grow.  Returned  to  the  sunlight,  they 
resumed  their  growth  and  advanced  further  in  one  day  than 
in  all  the  previous  thirty.  Placed  once  more  away  from  the 
sunlight  and  again  returned  to  normal  conditions,  they  grew 
to  stunted  froghood.  Just  such  an  experiment  society  tried 
with  babies  in  the  dark  rooms  of  New  York's  tenements,  and 
every  baby,  almost  without  exception,  born  and  kept  in  those 
rooms  died.  But  when  Jacob  Riis  and  others  tore  down  the 
windowless  walls  and  the  light  of  heaven  streamed  in,  the 
babies  began  to  live. 

In  our  cities  and  larger  towns  everywhere  we  are  still 
repeating,  in  a  measure,  the  same  experiment,  and  place  our 
children,  like  the  unfortunate  tadpoles,  in  darkened  homes, 
in  narrow,  shaded,  and  smoke-enveloped  alleys,  and  in  school- 
rooms into  which  the  sun  seldom  if  ever  enters — nay,  often  in 
schoolrooms  lit  even  in  the  middle  of  the  day  by  natural  or 
artificial  gas!  Bring  to  these  little  ones  medical  inspection, 
examine  their  eyes,  remove  their  adenoids,  protect  them  from 


39©  EDUCATIONAL  HYGIENE 

measles  and  all  the  rest,  but  shall  we  not  also  provide  a  play- 
ground where  for  a  part  of  the  day  they  may  bathe  in  the 
sun  as  God  alinighty  has  said  they  must  if  they  are  to  live! 

Exercise. -^Exercise  is  life,  and  the  absence  of  it  is  the 
sure  sign  of  death.  By  exercise  came  evolution.  Exercise 
shaped  the  body,  determined  the  vital  organs,  built  the  brain. 
By  exercise  the  child  takes  possession  of  his  inheritance  from 
the  race.  To  him  it  is  the  past,  the  present,  and  the  promise 
of  the  future. 

But  that  exercise  no  man  can  dictate,  no  teacher  devise, 
no  scholar  fully  define.  It  comes  forth  unbidden  from  the 
child,  declares  his  nature,  discovers  him  to  himself,  defines 
his  relation  to  his  mates,  shows  him  the  world.  It  is  his 
play;  it  is  himself.  Can  the  school  alone  do  this,  be  this? 
In  the  long  process  in  which  exercise  shaped  the  body  and  built 
the  brain,  there  was  determined  for  all  time  the  path  by  which 
the  child  must  come  into  his  own.  In  that  shortened  process 
we  call  childhood  every  faculty,  every  power,  every  organ 
that  fails  to  receive  its  due  exercise  shrivels,  and  health  by 
so  much  suffers,  and  by  so  much  the  man  becomes  less  a  man. 
It  would  require  a  book  to  speak  in  full  of  the  exercises  of  the 
playground  that  meet  the  needs  of  health — physical,  mental, 
moral,  aesthetic,  social  health;  for  all  these  are  elements  in 
the  health  of  the  body,  as  we  all  have  come  to  understand. 
But  in  many  respects,  in  the  very  nature  of  the  case,  these 
exercises  are  impossible  in  the  school-building;  they  are  pos- 
sible only  on  the  playground. 

Just  as  we  have  awakened  to  the  fact  that  the  school  pro- 
vides but  a  small  fraction  of  a  child's  education,  and  that  the 
environment,  which  included  everything  that  comes  into  the 
child's  experience,  is  teaching  him  every  waking  moment  of 
the  day,  so  we  have  come  to  understand  that  the  activities 
of  the  school  provide  but  a  small  fraction  of  the  exercise 
necessary  for  the  health  of  a  child  in  this  larger  meaning. 
In  the  long  process  of  race  development,  every  organ  and  in- 
stinct with  which  a  normal  child  is  born  has  been  tried  and 


PLAY  AND   PLAYGROUNDS  IN   CITIES  39 1 

found  good,  has  been  refined  and  passed  on,  and  some  yet 
higher  function,  some  yet  nobler  conduct  shall  spring  from 
their  roots.  Not  in  the  school  but  on  the  playground  can 
these  deep  instincts  of  workmanship,  imitation,  rivalry,  co- 
operation, find  their  true  and  genetic  expression,  and  as  the 
swift  seasons  roll  build  more  stately  mansions  in  the  soul. 
These  instincts  calling  from  the  deeps  of  the  child's  nature 
are  not  voices  calling  him  astray  or  to  delay  his  upward  prog- 
ress.^   They  are  the  voices  saying  to  him  and  to  the  race: 

"Build  thee  more  stately  mansions,  O  my  soul, 
As  the  swift  seasons  roll, 
Leave  thy  low-vaulted  past. 
Let  each  new  temple,  nobler  than  the  last. 
Shut  thee  from  Heaven  with  a  dome  more  vast, 
Till  thou  at  length  art  free, 
Leaving  thine  outgrown  shell  by  life's  unresting  sea." 

Play  and  Character.— We  have  not  always  understood  the 
real  nature  of  boyish  misdemeanors.  The  playground  is 
helping  us  to  understand.  Some  one  has  suggested  that  a 
boy  is  a  whole  menagerie.  This  is,  indeed,  a  rather  narrow 
limitation  of  a  boy's  relation  to  the  animal  kingdom.  In 
one  way  or  another,  he  seems  to  run  the  whole  gamut  of  the 
animal  kingdom.  He  crawls  like  a  worm;  he  creeps  like  a 
turtle ;  he  dives  and  swims  like  a  frog ;  he  walks  like  a  quad- 
ruped; he  climbs  like  a  monkey;  he  runs  like  a  deer;  he  squeals 
like  a  pig;  he  screeches  like  a  parrot;  he  hoots  like  an  owl;  he 
whistles  like  a  mocking-bird ;  he  sings  like  a  lark.  He  digs, 
builds,  roams,  hunts,  pillages,  hoards,  tames  wild  animals, 
and  makes  boon  companions  of  dogs;  dams  streams;  makes 
toy  weapons;  descends  beneath  the  waters,  under  snow  and 
into  the  bowels  of  the  earth.  He  ascends  to  housetops,  into 
trees,  and  there  abides;  he  tries  the  heavens  with  flying  toys, 
arrows,  balloons,  kites,  and  aeroplanes.     He  conjures  with 

'See  Thorndike's  volume  on  "The  Original  Nature  of  Man,"  Vol.  I  of  his 
"Educational  Psychology." 


392  EDUCATIONAL  HYGIENE 

the  stars,  creates  mysteries,  makes  rhymes,  composes  songs 
and  music,  dances,  and  fills  the  air  with  unearthly  din.  He 
teases,  mimics,  and  acts  many  parts;  he  competes,  does  stunts, 
undergoes  ordeals,  fights,  forms  gangs,  organizes  clubs,  and 
institutes  rituals.  There  is  no  creature  in  the  heavens  above 
nor  in  the  earth  beneath  nor  in  the  waters  under  the  earth 
which  he  does  not  at  times  become.^ 

We  have  suggested  under  "Why  Children  Play"  an  ex- 
planation of  this  panzoism  of  a  boy.  There,  also,  we  found  a 
suggestion  of  the  relation  of  play  to  certain  forms  of  misde- 
meanors. A  man  ran  away  from  his  usual  duties  one  day 
to  attend  a  session  of  the  juvenile  court.  He  wondered  if  he 
should  not  find  some  children  detained  there  for  committing 
acts  which  if  they  had  been  done  under  somewhat  different 
relations  would  have  been  not  only  right  but  even  desirable. 
He  was  not  disappointed.  Very  soon  nine  boys  were  called 
to  answer  to  the  charge  of  improper  snowballing.  They 
were  accustomed,  so  the  complainant  said,  to  gather  once  or 
twice  a  week  and  annoy  him  by  snowballing  his  house. 

The  Throwing  Instinct. — This  complaint  of  improper 
throwing  in  some  form  or  other  is  one  very  frequently  made 
against  boys  in  juvenile  courts.  Sometimes  it  is  for  breaking 
windows  in  vacant  houses,  sometimes  for  throwing  stones  at 
passenger  trains,  sometimes  for  annoying  somebody  with 
snowballs,  sometimes  for  throwing  a  baseball  in  the  streets. 
Judging  from  the  cases  in  the  juvenile  courts,  one  might 
easily  infer  that  the  passion  for  throwing  is  one  of  the  "original 
sins"  of  boyhood. 

We  will  not  stop  here  to  inquire  how  this  besetting  sin  got 
into  the  blood  and  nature  of  boys  and  how  it  is  passed  on  to  |( 
each  succeeding  generation.  It  is  obvious  enough  that  the 
art  of  throwing  must  once  have  meant  much  to  the  race, 
and  it  is  certain  that  all  normal  boys  are  "structurally  pre- 
disposed" to  throwing.  It  is  also  obvious  how  great  a  fas- 
cination this  art,  the  very  acme  of  which  is  exemplified  in  the  i^i 

'See  "Education  by  Plays  and  Games,"  by  the  writer. 


PLAY  AND   PLAYGROUNDS   IN   CITIES  393 

modern  baseball  pitcher,  has  for  the  people  generally  who 
flock  by  tens  of  thousands  to  witness  a  "battle  of  pitchers." 
We  can  scarcely  fail  to  acknowledge  this,  at  least,  that  the 
boy  comes  honestly  enough  by  it.  One  feels  very  confident 
that  if  those  nine  boys  had  been  gathered  into  a  gymnasium 
or  playground  and  allowed  to  play  indoor  baseball  and  basket- 
ball, as  they  were  not,  the  juvenile  court  would  not  have  heard 
of  them. 

The  Chasing  Instinct. — Looking  out  of  a  street-car  win- 
dow one  day,  I  chanced  to  see  a  boy  snatch  something  which 
looked  Hke  a  banana  from  a  stand  in  front  of  a  store  and  run 
with  all  speed  down  the  street.  There  was  something  about 
the  boy,  in  the  way  he  ran,  in  the  way  he  carried  himself,  in 
his  general  appearance,  that  somehow  gave  an  impression  not 
of  guilt  but  of  a  game,  and  one  wondered  whether  the  fellow 
was  eager  for  a  banana  or  for  excitement. 

A  boy  was  arrested  and  brought  to  our  juvenile  court 
for  stealing  apples.  He  was  warned  and  allowed  to  go.  Not 
long  after  he  was  in  court  again  for  stealing  apples.  He  was 
placed  under  a  probation  officer  and  sent  home.  Not  long 
after  he  was  again  arrested  and  brought  to  court  on  the  old 
charge  of  stealing  apples.  In  despair  the  probation  officer 
took  the  boy  aside  and  said:  "Now,  Tim,  tell  me  honestly, 
why  do  you  steal  those  apples?  Do  you  get  so  hungry  for 
apples  you  just  can't  help  steahng  them  ?"  The  boy  hung  his 
head  a  moment  and  a  new  thought  seemed  to  come  to  him. 
He  raised  his  head,  looked  up  at  the  probation  officer,  and 
said:  "Why,  I  don't  care  much  about  eating  'em,  but  I  do 
Hke  to  have  old chase  me." 

Is  this  passion  for  chasing  and  being  chased,  which  at  a  cer- 
tain age  crops  out  in  every  healthy  boy,  also  an  evidence  of 
total  depravity,  an  original  sin,  like  the  passion  for  throwing? 
A  study  of  juvenile  court  records  would  suggest  that  it  is. 
At  any  rate,  boys  at  a  certain  age  are  "structurally  predis- 
posed" to  running,  and  the  devil  entices  many  a  boy  to  evil 
by  means  of  it.    And  it  is  so  easy  for  him  to  do  this  in  the 


394  EDUCATIONAL  HYGIENE 

city!  The  city  streets  interfere  with  every  fair  game  of 
chase.  They  suggest  and  aid  only  the  unfair  games.  A  game 
of  tag  or  prisoner's  base  would  be  quickly  spoiled  in  the 
streets,  but  to  snatch  and  run  and  disappear  in  the  crowd  and 
get  away  for  good  is  easy. 

Collecting  Instinct. — ^There  is  another  besetting  passion  of 
boys,  the  passion  to  collect  and  hoard.  Probably  not  one  man 
in  ten  who  may  chance  to  read  this  article  failed  in  boyhood 
to  make  a  collection  of  something — buttons,  minerals,  birds' 
eggs,  bugs,  leaves,  tobacco-tags,  coins,  or  stamps.  In  the 
city  there  is  small  opportunity  for  the  legitimate  practise  of 
collecting.  About  all  that  boys  can  collect  is  what  they  buy. 
Three  boys  were  arrested  and  brought  to  the  juvenile  court 
for  looting  trinkets  from  a  ten-cent  store.  They  had  a  ren- 
dezvous where  they  hoarded  all  their  curious  collection. 
Another  boy  whom  the  writer  knew  was  taken  into  a  play- 
ground. Hs  had  the  reputation  of  being  the  toughest  boy  in 
the  public  school.  Under  the  direction  of  the  playground 
teacher  he  made  a  collection  of  bugs  and  butterflies.  He 
gathered  caterpillars,  fed  them,  made  cages  for  them,  watched 
them  spin  cocoons,  made  a  net,  caught  specimens,  mounted 
them,  and  his  collection  at  the  end  of  the  summer  was  a  pride 
to  him  and  to  his  teacher.  And  all  this  time  he  did  no  mis- 
chief. Who  will  say  that  the  future  thief  and  the  future 
scientist  do  not  sometimes  take  their  first  departure  from  each 
other  in  the  way  they  practise  the  collecting  instinct? 

Instinct  of  Construction. — Some  boys  were  brought  to  our 
juvenile  court  on  the  charge  of  mahcious  mischief.  They  had 
built  a  hut  in  a  vacant  lot.  They  were  bad  boys,  no  doubt, 
and  made  a  bad  use  of  the  hut,  perhaps,  but  do  not  boys 
come  honestly  enough  by  this  passion  to  build  and  own  a 
shelter?  What  would  the  world  be  to-day  but  for  this  in- 
stinct of  construction?  Had  there  been  a  proper  outlet  and 
direction  of  this  interest  of  the  boys,  the  majesty  of  the  law 
would  not  have  been  offended  and  the  divine  right  of  these 
boys  would  not  have  been  violated. 


PLAY   AND   PLAYGROUNDS   IN   CITLES  395 

Imitation  and  Suggestion. — Several  boys  in  our  city  went 
into  a  nickelodeon  and  saw  the  moving  pictures  of  "Fun  in  a 
Grocery  Store."  Not  many  nights  later  these  boys  broke 
and  entered  a  grocery  store.  They  took  very  Httle  away  with 
them,  but  the  store  was  a  sight  to  look  upon — bags  ripped 
open,  groceries  scattered  about,  and  the  grocer's  cat  left 
smothered  in  flour.  We  have  long  expressed  faith  in  the 
saying  that  example  is  better  than  precept,  but  in  practical 
life  we  often  abandon  our  boys  to  evil  suggestion  and  utterly 
desert  them  in  one  of  the  strongest  passions  of  the  human  race, 
that  of  the  drama. 

The  Social  Instinct. — One  day  in  winter  fourteen  boys  in 
a  certain  city  were  arrested  and  taken  to  the  police  station 
in  a  patrol  wagon.  They  had  been  hanging  around  the  rail- 
road station.  They  had  been  warned,  but  when  they  asked, 
"Where  shall  we  go?"  there  was  no  answer.  They  had  com- 
mitted no  mischief,  but  because  they  had  socialized  in  the 
warmest  place  except  a  saloon  that  was  open  to  them  they 
became  transgressors  of  the  law.  But  what  would  the  world 
be  like  to-day  if  it  had  not  been  for  this  instinct  for  getting 
together?  Upon  this  instinct  which  crops  out  so  strongly 
in  boys  in  their  early  teens,  in  a  crude  and  often  dangerous 
way,  really  depends  the  capacity  of  a  people  for  any  great 
public  or  national  achievement.  The  nations  of  the  earth 
that  stand  in  the  forefront  of  human  progress  are  the  nations 
which  have  shown  the  greatest  capacity  for  "getting  together," 
for  co-operative  action. 

As  one  studies  boys  he  becomes  more  and  more  convinced 
that  the  departure  from  right  to  wrong  is  often  far  too  subtle 
for  a  boy  to  realize  the  distinction  fully.  And  yet  the  most 
deep-seated  forces  of  his  nature  are  impelling  him  constantly 
onward  to  one  or  the  other.  If  he  does  the  right  thing  in  the 
wrong  way,  ten  to  one  society  is  far  more  to  blame  than  he 
is.  At  least,  this  is  the  conviction  of  the  advocates  of  play- 
grounds, and  consistently  with  their  belief  they  attempt  to 
supply  the  elements  in  a  boy's  environment  that  will  naturally 


396  EDUCATIONAL  HYGIENE 

and  safely  turn  his  energy  into  the  right  instead  of  the  wrong 
channel.  Of  course,  boys  will  throw  things.  A  place  is  pro- 
vided where  they  can  play  ball.  Of  course,  they  want  to  chase 
and  be  chased.  The  playground  provides  ample  opportunity 
for  running  games.  Of  course,  boys  collect  and  hoard.  Our 
playgrounds  direct  this  interest  also,  and  vacant  lots  and 
parks  yield  treasures  that  before  were  not  known  by  city 
boys  to  exist  at  all.  Of  course,  boys  will  build  or  else  destroy. 
The  playground  furnishes  a  chance  for  most  interesting  con- 
structive play  and  use  of  tools.  Of  course,  boys  will  imitate 
and  make  believe  and  dramatize.  Our  playgrounds  provide 
an  outlet  for  imitation  and  make-believe,  not  only  through 
the  dramatic  plays  and  games,  but  through  dramatic  clubs 
as  well.  Of  course,  boys  will  organize,  form  gangs  and  clubs. 
The  playground  offers  an  opportunity  for  the  most  interest- 
ing of  all  clubs  for  boys,  the  baseball  and  basket-ball  and 
football  teams.  That  the  playground  does  save  boys  from 
delinquency  is  the  uniform  testimony  of  probation  officers. 
Unfortunately,  few  statistical  studies  have  yet  been  made, 
but  one  made  in  Chicago  on  a  thoroughly  scientific  basis 
seemed  to  show  that  in  those  sections  of  the  city  where  play- 
grounds were  provided  there  was  a  decrease  in  delinquency 
of  from  eighteen  to  forty-eight  per  cent  as  compared  with  sec- 
tions of  the  city  where  there  were  no  playgrounds.  Public 
schools  notorious  for  truancy  and  disorder  have  been  prac- 
tically made  over  by  a  wise  and  systematic  use  of  the  school 
playground. 

The  Girl  Problem. — The  playground  throws  equal  light 
upon  the  girl  prolilem,  as  a  study  of  delinquent  girls  will 
show.  Society  generally  has  been  too  apt  to  place  women  in 
two  classes,  the  thoroughly  good  and  the  thoroughly  bad. 
Society  has  generally  regarded  boys  as  peculiarly  subject  to 
temptation  and  danger,  but  it  has  seemed  to  regard  girls  as 
good  by  nature  or  bad  because  they  wished  to  be  bad.  A 
great  deal  more  has  been  said  and  a  great  deal  more  has  been 
done  in  the  matter  of  preventive  work  for  boys  than  foi 


PLAY  AND   PLAYGROUNDS   IN   CITLES  397 

girls.  Until  within  a  few  years  the  work  for  girls  has  been 
more  largely  one  of  rescue  and  redemption  than  one  of  pre- 
vention. Boys'  clubs  have  been  more  numerous  than  girls' 
clubs,  and  most  playgrounds  have  been  planned  and  conducted 
to  meet  the  needs  of  boys  rather  more  than  to  meet  the  needs 
of  girls. 

But  is  it  true  that  girls  need  playgrounds  less  than  boys? 
Is  it  true  that  the  slum  home  is  less  bad  for  a  girl  than  for  a 
boy,  that  the  city  streets  are  safer  for  girls  than  they  are  for 
boys?  It  is  true  that  not  so  many  girls  as  boys  are  brought 
before  the  juvenile  court.  The  "besetting  sins"  of  girls  are 
not  so  many  as  those  of  boys;  at  least,  when  the  social  offenses 
of  girls  are  classified  they  do  not  represent  so  many  different 
classes  as  do  those  of  boys.  A  rough  classification  of  the 
cases  of  the  juvenile  court  for  one  year  showed  that  boys 
committed  nearly  three  times  as  many  different  kinds  of 
offenses  as  girls.  Boys  are  more  variable,  more  daring,  and 
more  original  in  their  offenses  than  girls,  but  the  misde- 
meanors of  girls  are  hardly  less  serious  than  those  of  boys. 
Moreover,  girls  coming  under  probation  seem  to  be  less 
amenable  to  improvement  than  boys.  The  records  of  the 
juvenile  court  for  one  year  showed  that,  while  three  out  of 
four  boys  satisfied  their  probation  requirements,  only  about 
one  girl  in  three  came  up  to  the  standard. 

In  certain  ways  the  slum  home  is  even  worse  for  the 
girl  than  it  is  for  the  boy,  and  the  streets  of  the  city  harm 
her  more  than  they  harm  him.  For  the  same  reason  the  play- 
ground becomes,  in  a  certain  sense,  more  helpful  to  girls  than 
to  boys,  more  necessary  in  supplying  those  elements  in  her 
life  that  her  home  environment  fails  to  give  her. 

Bringing  the  Playground  to  the  GirL — ^The  playground 
fight  for  the  welfare  of  girls,  as  the  playground  fight  for  the 
welfare  of  boys,  begins  by  enlarging  and  improving  the  envi- 
ronment. The  playground  brings  to  girls  a  new  environment 
almost  comparable  to  a  new  natural  world  for  them  to  live 
in.     Many  alleys  of  a  large  city  are  as  barren  of  growing 


398  EDUCATIONAL   HYGIENE 

things,  of  grass,  of  trees,  of  birds,  of  fresh  water  and  clean  soil, 
as  is  the  moon  itself.  All  the  things  that  little  children  should 
come  in  contact  with  these  alleys  seem  to  lack,  and  many, 
many  things  they  should  not  see  and  touch  and  hear  seem  to 
be  there.  A  biologist  once  selected  tadpoles  of  the  same 
parentage,  age,  size,  and  vigor  and  placed  them  in  a  series  of 
vessels  varying  regularly  in  size.  He  placed  the  same  number 
of  tadpoles  in  each  vessel  and  reared  them  under  exactly  the 
same  conditions,  so  far  as  possible,  except  as  to  the  size  of  the 
vessels.  At  the  end  of  a  certain  period  he  found  that  the 
tadpoles  had  developed  proportionately  to  their  environment, 
to  the  size  of  the  vessel  they  were  kept  in.  The  least  de- 
veloped tadpoles  were  in  the  smallest  vessel,  the  next  better 
developed  in  the  next  size,  and  so  on,  the  best  being  in  the 
largest  vessel.  Many  city  alleys  are  vessels  into  which  have 
been  crowded  many  little  human  tadpoles.  The  playground, 
however,  enlarges  the  vessel,  increases  and  improves  the  en- 
vironment, until  almost  a  new  world  comes  into  the  child's 
life.  There  is  water  to  wade  in,  there  is  clean  sand  to  dig  in, 
there  is  fresh  soil  to  plant  seeds  in,  there  are  grass,  and  shrubs, 
and  trees,  and  flowers,  and  little  gardens,  and  pets  to  feed  and 
play  with.  One  recalls  Luther  Burbank's  delightful  child's 
cosmos.  He  says  in  "The  Training  of  the  Human  Plant": 
"Every  child  should  have  mud  pies,  grasshoppers,  water- 
bugs,  tadpoles,  frogs,  mud-turtles,  elderberries,  wild  straw- 
berries, acorns,  chestnuts,  trees  to  climb,  brooks  to  wade  in, 
water-lilies,  woodchucks,  bats,  bees,  butterflies,  various  ani- 
mals to  pet,  hay-fields,  pine-cones,  rocks  to  roll,  sand,  snakes, 
huckleberries,  and  hornets.  And  any  child  who  has  been 
deprived  of  these  has  been  deprived  of  the  best  part  of  his 
education." 

Early  in  the  nineteenth  century  there  appeared  in  Nurem- 
berg a  boy  of  sixteen  years  of  age  about  whom  there  was  a 
great  mystery.  All  his  life  he  had  been  confined  in  a  dark 
room,  never  leaving  it.  He  was  as  ignorant  and  untrained  as 
an  imbecile,  but  under  instruction  showed  that  he  was  pos- 


School  play  activities  at  Milwaukee,  Wis. 
Note  arc  lights  for  night  use  of  playground.     Indoor  baseball,  basket-ball,  and  volley-ball 


Tennis  and  volley-ball  at  Pasadena,  Cal. 


i 


PLAY  AND   PLAYGROUNDS   LN  CITIES  399 

sessed  of  normal  original  powers  of  mind.  His  sad  condition 
awakened  great  sympathy  and  several  books  were  written  con- 
cerning him.  So  far  as  is  known,  this  case  is  the  only  experi- 
ment that  man  has  ever  tried  in  narrowing  to  the  limit  the 
environment  of  a  child.  But  one  recognizes  that  society  in  a 
certain  sense  is  constantly  repeating  the  experiment  of  the  un- 
fortunate Kaspar  Hauser  in  innumerable  children  of  the  slums. 
Few  people  can  easily  realize  how  restricted  is  the  world  of 
many  of  these  children,  how  narrow  is  their  environment,  how 
perverted  their  ideas  of  life.  Beulah  Kennard,  of  the  Pitts- 
burg board  of  education,  tells  the  following:  "A  little  girl  of 
the  playgrounds  said  to  her  teacher :  '  Have  you  ever  rode  in 
a  patrol  wagon  ?  My  father  has  three  times  and  mother  once, 
and  when  I  am  big  I  am  going  to.'  "  A  little  boy  in  the  tene- 
ment district  of  New  York  was  asked  what  signs  of  coming 
spring  he  had  noted,  and  he  said:  "The  swinging-doors  of  the 
saloons  are  on." 

The  Mother  Instinct  and  the  Doll. — Perhaps  Luther 
Burbank,  when  he  enumerated  what  every  child  should  have, 
was  thinking  of  boys  only,  for  he  failed  to  mention  the  doll. 
In  the  playground  the  little  slum  girl  finds,  perhaps,  her  first 
opportunity  to  re-experience  in  genuine  doll  play  the  racial 
joy  of  motherhood.  Real  doll  play  is  very  different  psycholog- 
ically and  educationally  from  the  prolonged  serious  care  of 
babies  which  falls  so  grievously  upon  many  young  shoulders 
too  weak  to  bear  it  and  which  lessens  the  possibihty  of  future 
joyous  motherhood  in  the  world.  The  playground  corrals 
out  of  the  wild  and  untrained  life  of  the  streets  the  homing, 
nurturing,  mothering  instincts  of  little  .girls,  feeds  them  and 
guides  them,  laying  the  idealistic  and  emotional  foundation 
for  enlightened  and  exalted  motherhood  to  an  extent  impos- 
sible in  the  slum  home. 

Playing-in-the- Water  Instinct. — "The  measure  of  civili- 
zation is  the  bath,"  says  some  one.  At  all  events,  the  bath  is 
associated  with  both  moral  and  physical  cleanness.  The  fight 
for  the  honor  of  girls  in  the  playground  includes  attention  to 


400  EDUCATIONAL   HYGIENE 

cleanliness.  For  little  folks  the  tub,  for  older  girls  the  shower 
or  the  swimming-pool  is  provided,  as  well  as  the  wash-bowl. 
These  give  the  playground  an  advantage  in  this  respect  over 
many  public  schools  which  have  no  bathing  facilities.  All 
is  easy  and  delightful  in  the  playground  provided  with  baths 
and  a  swimming-pool,  as  one  can  easily  imagine  who  has  wit- 
nessed the  mad  delight  of  children  in  the  water.  "You  can 
catch  more  flies  with  sugar  than  with  vinegar"  is  a  homely 
saying,  and  the  swimming-pool  is  a  lasting  monument  to  the 
efficiency  of  play  education.  The  deep-seated  aversion  to 
soap  and  water  is  swallowed  up  in  the  deeper  instinctive  love 
of  playing  in  the  water.  Children  would  go  through  fire, 
soap  and  water,  or  anything  else  to  get  to  the  swimrhing-pool, 
and  before  they  know  it  they  have  grown  to  enjoy  the  feeling 
of  cleanliness  and  to  regard  soap  and  water  for  what  they 
will  do  for  them. 

The  Playground  and  the  Races. — The  playground  work  is 
closely  related  to  the  problem  of  mixed  races.  Five,  six,  even 
ten  or  more  different  nationalities  are  found  represented  at 
the  same  time  in  a  single  playground.  Race  prejudice  ap- 
pears in  girls  as  well  as  boys.  One  pathetic  feature  is  the  well- 
known  tendency  of  the  children  of  foreign-born  parents  to 
despise  the  nation  and  customs  of  their  parents.  One  recalls 
the  story  told  by  Jacob  Riis.  Mr.  Riis  found  a  little  fellow 
crying  bitterly.  The  kindly  man  endeavored  to  comfort  the 
boy,  who  had  just  received  a  beating  from  his  father.  Finally, 
when  the  future  American  citizen  could  command  the  words 
and  a  steady  voice,  he  exclaimed:  *'/  don't  care  nothin'  for  the 
lickin\  but  I  hate  to  be  licked  by  a  Manned  foreigner."  It  is  not 
uncommon  for  girls  in  the  playground  or  social  centre  to  de- 
spise the  lace-making  or  other  skilled  hand -work  of  their 
kinspeople  until  they  see  the  admiration  of  the  teacher  for 
the  hitherto  despised  accomplishments  of  their  mothers,  and 
then  a  new  interest  and  a  new  sympathy  are  awakened  which 
mean  much  in  the  home. 

The  activity  of  the  playground  is  often  related  to  the  needs 


PLAY   AND   PLAYGROUNDS   LN   CITIES  4OI 

of  the  home.  Sewing  and  even  cooking  are  activities  in  some 
play  centres.  These  occupations,  which  to  many  women 
mean  only  drudgery  and  the  sweat-shop,  become,  under  the 
strange  alchemy  of  childhood,  occupations  of  interest  and 
delight.  These  occupations  become  as  popular  as  the  games 
if  offered  to  the  girls  at  an  age  when  the  constructive  inter- 
ests are  awakening.  When  seized  at  the  right  time  and  fixed 
in  habit,  this  interest  abides  for  good  and  the  girl  advances 
safely  over  a  critical  period  and  is  further  along  on  the  way 
toward  the  woman  who  "looketh  well  to  the  ways  of  her 
household  and  eateth  not  the  bread  of  idleness." 

Athletic  games  have  long  been  regarded  as  moral  prophy- 
lactics for  boys,  but  it  is  only  comparatively  recently  that 
active  games  have  been  regarded  as  serving  a  similar  purpose 
in  the  case  of  girls.  If  boys  especially  need  some  morally  and 
physically  healthful  and  absorbing  interest  outside  of  them- 
selves, it  is  equally  true  that  girls  have  been  less  Hkely  than 
boys  to  find  such  interests.  Many  running  games  and  ball 
games,  if  properly  conducted,  serve  as  good  a  purpose  in  the 
case  of  girls  as  ever  they  do  in  the  case  of  boys.  Girls  in  the 
street  are  even  less  Hkely  than  boys  to  learn  the  games  they 
should  know  and  the  w^ay  they  should  play  them.  If  the  street 
is  a  bad  play  school  for  boys,  it  is,  for  obvious  reasons,  surely 
worse  for  girls.  The  traditional  folk-games  which  have 
held  a  large  place  in  the  street  play  of  girls  are  very  apt  to 
acquire  objectionable  features  in  the  streets.  The  play- 
ground elevates  and  enlarges  the  play  repertoire  of  girls  pro- 
portionately even  more  than  it  does  that  of  the  boys.  IVIany 
beautiful  folk-games  and  folk-dances,  moreover,  would  be  en- 
tirely unknown  to  the  children  of  the  streets  were  it  not  for  the 
supervised  play  of  the  playground.  Many  of  the  games  and 
dances  of  foreign  parents  become  known  and  preserved  in 
their  children  through  the  playground  which  otherwise  would 
not  be  learned,  or  if  learned  would  be  despised  by  the  children 
in  the  process  of  Americanization. 

The  love  of  finery  which  tempts  a  girl  to  pilfer  cheap 


402  EDUCATIONAL   HVGIENE 

jewelry  from  the  department  stores,  or  to  steal  money  to  buy 
better  clothes  to  wear,  is  not  so  very  distantly  related  to  the 
love  of  beauty.  The  cultivation  of  the  love  of  the  beautiful 
doubtless  stimulates  the  moral  sense  also,  but  if  that  were 
not  the  case  the  playground  arts  and  crafts  open  a  legitimate 
way  to  the  enjoyment  of  beauty  in  form,  in  color,  or  texture, 
that  is  salutary  if  not  morally  elevating.  The  girl  who  can 
fashion  a  beautiful  belt-buckle  in  bronze  from  a  design  of  her 
own,  or  can  embroider  a  belt,  or  make  a  bit  of  lace,  or  design 
and  embroider  her  collars  and  cuffs,  is  thereby  inoculated 
against  pilfering  similar  articles  for  the  adornment  of  her 
person. 

The  moving- picture  show  is  sometimes  prominent  in  the 
history  of  wayward  girls.  This  great  educational  possibility, 
often  turned  over  to  low  commercial  exploitation  and  cor- 
rupted with  evil  associations,  is  fast  becoming  a  social  rendez- 
vous for  boys  and  girls.  Unfortunately,  also,  as  a  rule,  the 
more  needy  the  people  the  lower  is  the  standard  of  the  pic- 
tures. Through  its  appeal  to  the  dramatic  interest  of  children 
and  by  its  children's-theatre  work,  the  playground  or  play 
centre  offers  a  counter-attraction  to  the  undesirable  cheap 
theatre  or  nickelodeon  and  is  steadily  uplifting  the  dramatic 
standards  of  boys  and  girls.  Moving  pictures  have  already 
begun  to  take  their  place  among  the  features  of  playground 
work  in  many  cities  and  much  hope  is  entertained  for  their 
high  value  in  the  near  future. 

Play  and  Moral  Education. — Thus  in  many  ways  the  play- 
ground serves  as  a  safeguard  to  character.  But  the  relation 
of  play  to  character  is  not  confined  to  prophylactics.  Play  has 
a  definite,  positive  effect  in  moral  training.  Play  doubtless  of- 
fers the  best  opportunity  for  the  development  of  fundamental 
traits  of  character.  This  is  evident  when  we  consider  the 
relation  of  play  to  conservation.  Just  as  it  is  the  office  of 
the  instincts  to  conserve  racial  habits,  so  it  is  the  office  of 
play  to  habituate  to  certain  moral  reactions.  "If,"  says 
James,  "a  boy  grows  up  alone  at  the  age  of  games  and  sports, 


A  volley-ball  game  over  a  tennis-net,  Oak  Park  Grammar  School, 
Sacramento,  Cal. 


Girls  at  playground  ball  and  volley-ball;   boys  at  tennis 
Basket-ball  goals  also  in  evidence,  Pasadena,  Cal. 


PLAY  AND   PLAYGROUNDS   IN   CITLES  403 

and  learns  to  play  neither  baseball,  nor  row,  nor  sail,  nor  ride, 
nor  skate,  nor  fish,  nor  shoot,  probably  he  will  be  sedentary 
to  the  end  of  his  days;  and,  though  the  best  of  opportunities 
be  afforded  him  for  learning  these  things  later,  it  is  a  hundred 
to  one  but  he  will  pass  them  by  and  shrink  back  from  the 
effort  of  taking  those  necessary  first  steps  the  prospects  of 
which  at  an  earlier  stage  would  have  filled  him  with  eager 
delight."  So,  on  the  moral  side,  if  a  boy  grows  up  alone  and 
does  not  learn  to  play  games  which  call  for  great  activity, 
competition,  courage,  fortitude,  perseverance,  fairness,  gener- 
osity, loyalty,  co-operation,  sacrifice,  he  loses  the  most  favor- 
able opportunity  for  the  development  of  these  traits  in  him. 

Providing  Playgrounds. — While  the  statement  of  Doctor 
Woods  Hutchinson,  "Better  a  playground  without  a  school 
than  a  school  without  a  playground,"  has  naturally  not  re- 
ceived instant  and  universal  approval,  yet  the  essential  idea 
in  the  statement  commends  itself  to  every  thoughtful  student 
of  city  conditions.  Playgrounds  are  needed  proportionately 
as  schools  are  needed,  and  a  city  that  has  located  its  schools 
with  foresight  and  wisdom  needs  at  least  as  many  playgrounds 
as  schools. 

Naturally  there  has  been  a  tendency  to  purchase  new 
playgrounds  apart  from  school-buildings.  First,  because 
land  is  usually  less  available  and  more  expensive  adjoining 
school-buildings  than  in  some  other  section  of  the  city,  and, 
second,  because  the  people  interested  in  providing  playgrounds 
have  not  realized  the  very  great  advantage  of  having  play- 
grounds adjacent  to  schools.  Obviously,  however,  the  school 
is  the  natural  civic  and  social  centre  of  a  neighborhood,  and 
there  would  be  a  great  economy  in  construction,  equipment, 
and  administration,  as  well  as  increased  use,  if  the  school  plant 
were  at  once  the  centre  of  the  social  and  the  play  and  recre- 
ational activities  of  the  neighborhood  and  served  as  a  school, 
a  small  park,  a  playground,  and  a  neighborhood  home  all  in 
one.  At  present  there  is  no  consensus  of  opinion  as  to  how 
large  such  a  school  playground  should  be.     States  that  have 


404  EDUCATIONAL  HYGIENE 

passed  laws  requiring  that  when  new  school-buildings  are 
erected  an  adequate  playground  shall  be  provided  do  not 
state  how  large  an  adequate  playground  would  be.  Obviously 
the  size  of  school  playgrounds  in  cities  generally  has  been 
determined  by  the  cost  of  land  and  not  by  the  needs  of  the 
children.  Perhaps  city  playgrounds  must  always  be  too 
small.  Yet  with  the  increased  facilities  of  transportation 
and  in  view  of  the  experiments  already  successfully  tried  in 
the  consolidation  of  schools,  the  free  transportation  of  school- 
children, and  the  providing  of  lunches,  it  seems  wholly  war- 
rantable to  state  that  there  is  no  sufficient  reason  why  any 
city  should  not  in  some  manner  provide  an  adequate  play- 
ground for  every  school. 

What  constitutes  an  adequate  playground,  however,  is 
yet  to  be  determined.  School  playgrounds  in  American 
cities  vary  all  the  way  from  practically  nothing  at  all  to  several 
acres.  Standards  have  been  suggested,  such  as  thirty  square 
feet  of  space  per  child,  one  hundred  square  feet  per  child,  a 
block  per  school,  and  others.  It  is  obvious  that  the  efficiency 
of  a  playground  is  not  determined  by  its  size  so  much  as  by 
its  administration  and  use.  At  present  it  seems  impossible 
to  determine  any  universal  standard  for  size  of  school  play- 
grounds. Playgrounds  must  be  large  enough  and  admin- 
istered in  such  manner  as  will  provide  ample  opportunity  for 
the  plays  and  games  which  are  essential  in  the  education  of 
children.  To  discuss  these  plays  and  games  adequately  is 
not  possible  here.^ 

Standards.— But  not  to  leave  the  subject  of  the  size  of 
school  playgrounds  wholly  without  definite  suggestions,  it  may 
be  said,  after  a  careful  consideration  of  the  general  problem 
and  of  the  space  needed  for  educationally  essential  plays  and 
games,  that  a  minimum  standard  for  school  yards  should  be: 
for  every  elementary  school  of  less  than  loo  children  a  play 
space  of  ten  thousand  square  feet  exclusive  of  school-buildings. 

^  See  Bancroft's  "Games  for  Playground,  Home,  and  School,"  and  John- 
son's "Education  by  Plays  and  Games." 


PLAY  .A>rD   PLAYGROL'XDS   IX   CITIES  405 

For  elementary  schools  of  100  or  more  children  there  should 
be  added  4,000  square  feet  per  each  additional  100  children 
or  fraction  thereof.  Thus,  for  a  school  of  200  children  we 
should  have  as  a  minimum  a  school  yard  of  18,000  square  feet, 
or  a  plot,  say,  180  by  100  feet  exclusive  of  the  buildings;  for 
a  school  of  1,000  children  a  play  space  of  50,000  square  feet, 
or  a  plot,  say,  200  by  250  feet.  This  is  a  minimum  standard 
and  is  not  adequate  for  such  games  as  regulation  baseball 
and  football,  but  with  skilful  administration  and  rotation 
of  groups  it  would  serve  well  the  need  of  elementar\-  schools. 
But  where  the  school  with  its  playground  is  to  serve  as  a 
social  and  recreation  centre  for  the  neighborhood,  it  cannot 
adequately  meet  the  needs  of  the  neighborhood  with  less  than 
four  acres,  while  from  sLx  to  twelve  acres  are  desirable  accord- 
ing to  the  density  of  the  population.  Four  acres  is  the  very 
minimum,  and  is  necessary  in  order  to  meet  the  problems  of 
"composition,"  track  and  field  sports,  football  and  baseball, 
the  divisions  of  the  playground,  etc. 

Equipment  and  Apparatus. — We  have  not  advanced  very 
far  in  the  science  of  playground  equipment  and  apparatus. 
Most  conclusions  have  been  arrived  at  empirically.  Yet 
there  are  a  few  underlying  principles  which  we  may  even  now 
apply  in  attempting  to  determine  what  should  be  provided 
as  mechanical  aids  to  the  play  of  children. 

What  we  know  of  child  development  and  child  ps>'chology 
indicates  that  the  educational  import  of  the  first  six  years  of 
life  is  to  a  large  extent  the  development  of  the  senses  and  ac- 
quiring of  sense  facts,  getting  control  of  the  fundamental 
movements  of  the  body  and  limbs,  habituating  to  physical 
activities,  the  beginning  of  sociability,  development  of  speech, 
imitation,  imagination,  and  self-assertion.  Obviously,  the 
race  in  its  development  was  in  unhindered  contact  with  the 
forces  and  elements  of  nature.  Under  crowded  city  conditions 
this  natural  relation  to  and  contact  with  earth,  water,  plants, 
trees,  animal  life,  and  a  thousand  and  one  natural  objects  are 
greatly  restricted.     It  is  the  office  of  the  playground  to  re- 


406  EDUCATIONAL  HYGIENE 

store  in  such  degree  as  is  practicable  the  relation  of  the  child 
ti)  the  objects  and  forces  of  nature.  Our  equipment  and 
apparatus,  therefore,  should  provide  play  involving  the  sense 
impressions  otherwise  lost  in  city  life — such  as  the  contact  of 
hands  and  feet  and  body  with  clean  earth,  sand,  clay,  as  in 
the  sand-pile  and  in  modelling  with  mud  or  clay;  the  contact 
with  water  as  in  a  wading-pool  (or  in  shallow  troughs  in  the 
case  of  the  youngest);  constructive  play  with  crude  raw 
material,  as  in  the  sand-box  with  sand  and  clay,  blocks,  stones, 
sticks,  etc. ;  the  delightful  emotional  shocks,  the  playful  sense 
of  danger,  difficulty,  achievement,  as  in  jumping  downward, 
flying  through  the  air,  falling,  sliding,  climbing,  clinging,  bal- 
ancing, experienced  in  play  with  such  apparatus  as  the 
swing,  the  slide,  the  see-saw,  jumping-hole,  and  raised-rail  or 
walking-beam.  The  imitative  and  imaginative  play  at  this 
age  also  requires  a  great  variety  of  simple  toys,  dolls,  carts, 
reins,  toy  household  utensils,  and  the  like,  which  the  play- 
ground may  legitimately  provide.  The  social  needs  of  this 
period  are  admirably  met  in  the  playing  together  in  sand  or 
water,  on  the  slide  or  see-saw,  in  climbing,  jumping,  and 
walking  in  difficult  places  or  ways  together,  the  relations  in- 
volved developing  sociability  and  the  regard  for  rights,  yet 
respecting  individuality  and  self-assertion  desirable  at  this 
age. 

In  the  case  of  children  over  six  and  under  ten,  similar 
needs  are  recognized  and  similar  but  somewhat  more  difficult 
activities  should  be  aided  by  the  equipment  and  the  ap- 
paratus. In  addition,  also,  there  should  be  supplied  apparatus 
for  simple  games  of  competition  and  skill — balls,  bean-bags, 
ring-toss,  tenpins,  etc. 

The  apparatus  for  children  from  ten  to  twelve  should 
meet  the  needs  of  the  developing  co-ordination  of  the  sensory 
and  motor  apparatus.  More  ambitious  "stunts"  should  be 
suggested  by  the  teeter-ladders,  the  giant  stride,  the  general 
outdoor  gymnastic  apparatus  and  swimming-pool,  also  balls, 
bats,  quoits,  goals,  jumping  and  vaulting  standards,  jump- 


I 


PLAY   AND   PLAYGROUNDS   IN  CITIES  407 

lanes,  running- track,  etc.  Up  to  this  point  the  suggestions 
offered,  with  a  few  obvious  exceptions,  apply  nearly  equally 
well  to  both  boys  and  girls. 

From  thirteen  or  fourteen  on,  in  the  case  of  boys  more 
stress  should  be  laid  upon  the  co-operative  competitive  games: 
baseball,  basket-ball,  football,  track  and  field  events,  for  which 
familiar  apparatus  is  necessary. 

This  very  brief  discussion  of  the  principles  underlying  the 
selection  of  apparatus  suggests  the  division  of  playgrounds 
to  meet  the  needs  of  at  least  three  groups:  children  under 
ten,  girls  over  ten,  boys  over  ten.  A  further  division,  of  ap- 
paratus at  least,  for  children  seven  to  nine  would  be  ad- 
vantageous. The  age  limits  mentioned,  of  course,  are  not 
intended  to  be  applied  with  exactness.  Individual  differences 
in  temperament  and  development  should  determine  division 
rather  than  the  exact  age. 

There  is  great  advantage  in  fencing  a  playground  and  in 
fencing  off  divisions  when  such  is  practicable,  as  a  matter  of 
safety,  psychological  value,  and  ease  of  administration. 

It  is  not  the  purpose  of  this  chapter  to  go  into  the  con- 
struction of  apparatus.  Much  of  the  apparatus  mentioned 
above  can  be  made  easily  by  a  good  mechanic.  Nearly  all 
of  it  can  be  bought  now  ready-made. 

Playground  Administration. — We  have  had  developed  in 
this  country  within  the  last  ten  or  twelve  years  four  types  of 
public  playgrounds:  the  reorganized  school  playground,  the 
small  detached  playground,  the  larger  detached  playground 
or  recreation  park  or  small  park,  the  reorganized  large  park. 
The  adequate  consideration  of  these  types  of  playgrounds 
would  involve  a  discussion  of  organizing  and  administrative 
agencies  for  the  conduct  of  play  and  recreation  centres.  The 
various  types  of  playgrounds  mentioned  have  developed  be- 
cause of  the  various  agencies  which  created  or  reorganized 
them.  Park  boards  have  established  outdoor  gymnasia  and 
children's  playgrounds  in  the  large  parks  and,  separate  from 
the  large  parks,   the  recreation  park  or  recreation  centre. 


408  EDUCATIONAL   HYGIENE 

Playground  associations  and  playground  commissions  have 
established  detached  small  playgrounds  and  recreation  parks. 
School  boards  have  reorganized  school  playgrounds  and  es- 
tablished recreation  or  social  centres  in  pubhc-school  buildings. 
The  "Year  Book  of  the  Playground  and  Recreation  Association 
of  America  for  191 2-13"  shows  that  playground  commissions 
were  concerned,  alone  or  in  combination  with  other  organiza- 
tions, in  maintaining  play  centres  in  46  communities,  park 
boards  in  55  communities,  boards  of  education  in  56  commu- 
nities, playground  associations  in  68  communities,  and  miscel- 
laneous agencies  in  116  communities. 

Obviously,  each  agency  has  been  influenced  by  its  own 
view-point  in  determining  the  characteristics  and  the  location 
of  its  play  centres.  Whether  city  playgrounds  are  to  be  de- 
veloped and  administered  as  a  part  of  the  public  education 
system  or  as  a  part  of  the  park  system,  or  under  some  new 
agency  independently  of  both  educational  and  park  systems, 
so  far  as  the  immediate  future  is  concerned,  will  doubtless  be 
determined  mainly  by  local  conditions.  The  ultimate  trend, 
however,  will  doubtless  be  determined  by  the  answers  to  the 
following  questions: 

(i)  Are  playground,  recreation,  and  social-centre  problems 
mainly  physical,  moral,  and  social-education  problems  or  pub- 
lic-convenience problems  ? 

(2)  Can  play,  recreation,  and  social  centres  be  acquired  or 
developed  more  economically  under  the  school  system,  the 
park  system,  or  some  new  agency? 

(3)  Under  which  agency  can  the  centres  be  most  efficiently 
and  economically  administered? 

Quite  evidently,  so  far  as  children  of  school  age  are  con- 
cerned, the  problems  are  predominantly  educational  and  nat- 
urally and  logically  belong  under  the  educational  system. 
It  is  perfectly  evident  also  that  so  far  as  the  general  neigh- 
borhood is  concerned  the  problems  are  those  of  physical, 
moral,  and  social  education  far  more  than  of  public  conve- 
nience and  administration. 


w 


PLAY  AND   PLAYGROUNDS   IN   CITIES  409 

Local  conditions  enter  more  prominently  into  the  con- 
sideration of  the  second  question,  but  here,  so  far  as  children 
of  school  age  are  concerned  and  so  far  as  evening  activities 
of  the  public  generally  are  concerned,  the  centres  can  be 
acquired  or  developed  more  economically  under  the  educa- 
tional body  with  its  present  vast  sums  invested  in  buildings 
and  grounds  than  under  any  other  pubHc  body. 

So  far  as  the  problems  are  educational  and  so  far  as  the 
activities  of  school  age  or  evening  activities  of  the  general 
public  are  concerned,  the  educational  body  has  the  decided 
advantage  over  all  other  bodies  in  the  matter  of  efficient  and 
also  economical  administration.  So  far  as  the  outdoor,  day- 
time activities  requiring  large  areas  or  water-fronts,  such  as 
golfing,  motoring,  horseback-riding,  dri\dng,  picnics,  boating, 
sailing,  canoeing,  ocean  and  river  bathing,  etc.,  are  concerned, 
the  park  board  seems  to  hold  as  natural  and  logical  a  position 
as  the  educational  body  in  the  case  of  the  others.  But  it  would 
seem  that  so  far  as  organized,  supervised,  or  directed  plays, 
games,  and  sports  are  concerned,  whether  in  small  centres 
or  by  privilege  of  park  boards  in  large  parks,  one  body  should 
be  responsible  for  all  and  this  body  naturally  and  logically 
would  be  the  educational  one. 


CHAPTER  XXII 
PHYSICAL   EDUCATION   IN   ELEMENTARY   SCHOOLS 

Definition. — Physical  education  is  the  training  of  body  and 
mind  by  motor  work.  This  broad  definition  includes  certain 
forms  of  physical  training,  such  as  drawing,  manual  training, 
writing,  and  the  like,  which  are  usually  considered  separate 
subjects.  In  addition,  however,  physical  training  properly 
includes  certain  health  activities,  such  as  hygiene,  bathing, 
physical  examinations,  and  medical  inspection. 

In  elementary  schools  physical  training  should  include 
folk-dancing,  games,  story  gymnastics,  athletics,  gymnastics, 
instruction  in  hygiene,  and  medical  inspection.  The  last 
two  will  be  omitted  from  this  chapter  and  considered  else- 
where. 

Purposes. — Physical  training  has  two  major  aims,  health 
and  motor  education.  The  author  has  divided  all  physical- 
training  procedure  according  to  the  purpose  and  function  of 
the  exercises  into  the  following  classes,  all  of  which  appear  in 
proper  sequence  in  a  typical  lesson  as  shown  in  table  on 
next  page. 

This  formation  of  the  day's  order  is  new  and  is  based 
upon  the  principle — selection  and  segregation  of  exercises  ac- 
cording to  their  function.  It  recognizes  the  fact  that  for  the 
various  purposes  of  physical  training  different  exercises  and 
different  methods  are  indicated.  Their  separate  pursuit 
eliminates  all  necessity  for  compromise  in  choice  of  matter 
and  method.  Moreover,  it  permits  the  attention  of  teacher 
and  pupil  to  be  centred  on  one  thing  at  a  time,  and  the  result- 
ing singleness  of  purpose  allows  the  teacher  and  pupil  to  un- 
derstand the  aim  of  the  procedure.    This  stimulates  interest 

410 


PHYSICAL   EDUCATION   IN   ELEMENTARY    SCHOOLS      41I 


Typical  Content 

Typical  Method 

Results 

Introductory. 

Military. 

Response  commands 
for   alertness   and 
precision. 

Floor         formation; 
mental     and     so- 
matic preparation 
for  the  lesson. 

Corrective. 

1.  Static. 

2.  Short  range. 

3.  Slow  movements. 

Elevation  cues;  sus- 
tained contraction. 

Good  posture. 

Educational. 

Gymnastics   empha- 
sizing accuracy. 

Response  commands. 

Neuromuscular   and 
psychomotor  edu- 
cation: inhibition, 
precision,       alert- 
ness. 

Hygienic. 

Exercises   of   trunk, 
leg,  and  back,  rapid 
and  heavy. 

Rhythmic ;        serial 
commands. 

Organic  stimulation; 
development  of  ab- 
dominal muscles. 

Recreative. 

Natural       exercises, 
i.    e.,       athletics, 
games,  dances. 

Rhythmic;  music  or 
no  commands. 

Knowledge  of  exer- 
cises.    Happiness. 
All  educational  and 
hygienic  results. 

Assembly. 

Military. 

Response  commands. 

Control  and  quiet. 

and  arouses  co-operation,  often  wanting,  particularly  in  formal 
gymnastics.^ 

I.  Introductory  exercises  are  for  the  purpose  of  {a)  form- 
ing the  class  for  work;  {h)  mildly  stimulating  the  body  in 
preparation  for  harder  work ;  and  (c)  placing  the  class  mentally 
en  rapport  with  the  teacher.  The  content  is  composed  of  the 
simplest  and  best-known  exercises,  mainly  marching  and  fac- 
ing to  response  commands. 

II.  Corrective  exercises  are  designed  to  improve  bad  pos- 
ture and  insure  good  posture. 

Good  posture  is  {a)  a  good  adjustment  of  body  parts  to  each 
other  so  that  they  may  function  to  best  advantage  and  {h)  a 
good  adjustment  oj  the  body  to  its  environment,  task,  or  work. 
All  bad  adjustment  of  body  parts  to  each  other  is  a  ptosis 
{i.  e.,  a  depression  of  body  parts)  due  to  acute  or  chronic 
fatigue.     It  is  usually  associated  with  blood  ptosis.     It  can 

'  See  chapter  on  "  Acquiring  Motor  Control "  in  Parker's  "  Methods  of  Teach- 
ing in  High  Schools." 


412  EDUCATIONAL  HYGIENE 

be  corrected  only  by  good  hygiene  (including  hygienic  exer- 
cises, in  which  the  strengthening  of  the  abdominal  muscles 
has  a  most  important  part)  and  elevation  exercises  specifically 
designed  to  train  the  pupil  in  good  posture  and  to  strengthen 
muscles  which  support  correct  posture. 

Corrective  work  has  four  phases,  namely: 

(i)  Corrective  cues. 

(2)  Corrective  exercises. 

(3)  Devices. 

(4)  Hygiene  and  hygienic  exercises. 

(i)  Corrective  cues  are  elevation  commands  such  as  "head 
up,"  "chest  up,"  "stand  tall,"  "stretch  the  body  upward," 
which  are  primary,  and  others  which  are  secondary,  such  as 
"waist  flat,"  "weight  forward,"  etc.  Other  homely  appeals, 
such  as  "stand  like  a  soldier"  and  "have  some  style  about 
you,"  have  a  direct  effect.  All  cues  leading  to  forward  or 
backward  correction  are  bad,  because  {a)  they  do  not  pro- 
duce elevation,  (&)  there  is  no  objective  limit  to  their  range 
and  the  proper  point  cannot  be  stated  definitely,  and  (c)  they 
lead  to  faulty  posture.  Hence,  "neck  back  against  collar," 
"shoulders  back,"  "chest  out"  must  be  discarded,  and 
"weight  forward"  is  to  be  omitted  when  possible.  Cues 
should  be  used  in  every  lesson  to  obtain  good  posture. 

(2)  Corrective  exercises,  (a)  Static  exercises  consist  of  posi- 
tions which  lift  the  chest  and  head  and  hold  the  position 
raised  to  the  utmost  (from  three  to  six  seconds)  while  eleva- 
tion cues  are  used.  These  are  the  most  important  and  ef- 
fective corrective  exercises  and  are  peculiar  to  this  system. 
(b)  Vigorous  exercises  of  upper  dorsal  and  posterior  neck 
muscles  limited  to  the  last  one-fourth  or  one-fifth  of  their 
range  of  movement.  These  shorten  and  strengthen  the 
muscles  which  support  good  posture.  These  are  of  minor 
importance,  (c)  Slow  movements  of  the  arms  with  which  is 
associated  the  idea  of  elevation  of  parts. 

III.  Devices.  Good  posture  is  a  matter  of  habit  and  pride 
as  well  as  of  physical  tone,  hence  the  following  devices  assist 


PHYSICAL  EDUCATION  IN  ELEMENTARY   SCHOOLS      413 

in  obtaining  it:  (a)  Marking  pupils  in  posture,  (b)  Dividing 
the  class  into  two  or  more  groups  according  to  posture  habits. 
(c)  Noting  posture  by  teacher  or  monitors  at  times  other  than 
during  the  gymnastic  lesson,  (d)  Permitting  pupils  to  vote 
on  good  or  bad  posture  of  all  other  pupils  in  turn,  (e)  As- 
signment of  home  exercises.  (/)  Special  work  with  the  poor- 
posture  group,  the  "Slouch  Class." 

The  following  rules  should  be  applied  to  corrective  exer- 
cises : 

(i)  The  exercises  must  be  simple  and  easy  to  do.  The 
whole  attention  of  teacher  and  pupil  must  be  centred  upon 
the  result  (i.  e.,  good  posture).  There  must  be  no  distraction 
from  this  result  on  the  part  of  the  teacher  in  preparing  the 
exercise,  in  making  it  serve  its  single  and  proper  purpose, 
nor  on  the  part  of  the  pupil  in  understanding  or  doing  it. 

(2)  It  must  not  be  contra-corrective.  "Neck  firm,"  "arms 
back  and  down"  are  open  to  serious  objection  and  are  not 
to  be  used  unless  other  exercises  will  not  serve. 

(3)  The  exercise  must  be  effective  in  actually  correcting  the 
fault,  and  in  addition  overcorrecting  it. 

(4)  There  is  no  "  gymnastic  ^^  progression  in  corrective  ex- 
ercises.   The  fewer  different  exercises  used  the  better. 

(5)  Throughout  the  gymnastic  period: 

(a)  No  contra-corrective  exercise  should  be  chosen  for  any 
purpose  unless  no  other  exercise  will  serve. 

(b)  All  else  being  equal,  the  exercises  which  have  a  posi- 
tive corrective  value  should  be  preferred  for  any  purpose. 

(c)  Good  posture  should  be  insisted  upon  at  all  times, 
though  this  must  be  secondary  to  the  main  purpose  of  the 
matter  in  hand. 

(d)  Accuracy  is  to  be  obtained  especially  in  introductory 
and  educational  work.  For  these  purposes  should  be  chosen 
exercises,  the  correct  performance  of  which  will  result  in  good 
posture. 

(e)  All  exercises  should  have,  if  possible,  a  strong  elevation 
position.     This  should  be  emphasized. 


414  EDUCATIONAL  HYGIENE 

(/)  All  "return  to  position"  after  an  exercise  should  be  a 
return  to  good  standing  posture. 

Educational  Exercises. — Physical  training  has  the  follow- 
ing educational  functions: 

First,  the  learning  of  useful  movements. 

(i)  For  use  in  ordinary  daily  life,  i.  e.,  how  to  walk,  cHmb 
stairs,  sit  down,  stand  up. 

(2)  For  use  in  emergency.  Jumping  (on  and  off  cars), 
running,  and  climbing.  It  is  useful  to  train  pupils  to  respond 
to  an  unexpected  command,  i.  e.,  Jump — (front,  back,  right, 
or  left). 

(3)  For  use  in  an  avocation.  Tennis,  baseball,  golf,  ath- 
letics, running,  etc.,  to  develop  a  taste  and  ability  to  indulge 
in  healthful  recreation. 

(4)  For  artistic  use.  Dancing  and  heavy  apparatus  work 
of  the  exhibition  type. 

(5)  For  subsequent  use  in  gymnastics. 

Second,  the  development  of  fundamental  neuromuscular 
abilities. — Accuracy  as  to  time  and  place,  alertness,  speed, 
grace,  economy,  and  co-ordination  of  movement. 

Third,  reflex  mental  results.— (i)  Inhibition.  This  is  the 
ability  to  withhold  from  action  until  the  proper  time.  It  is 
developed  by  sustaining  the  pause  in  the  response  command 
and  varying  it  so  that  the  pupils  are  held  in  a  state  of  alert- 
ness ready  to  move  upon  the  executive  command.  (2)  Ac- 
curacy, speed,  and  alertness  in  movement  result  in  the  de- 
velopment of  the  same  mental  qualities. 

Concentration,  directness,  clearness  of  thought,  and  the 
formation  of  complete  motor  images  with  respect  to  physical 
activity  and  control  are  among  the  most  important  educa- 
tional results  of  physical  training.  All  these  are  dependent 
upon  training  in  accuracy. 

Fourth,  esthetic  mental  training. — Every  body  position  and 
bodily  movement  induces  a  corresponding  mental  state,  and 
is  just  as  important  to  mental  development  as  food  is  to  the 
tissues.     Inasmuch  as  extensor  positions  are  probably  corrc- 


PHYSICAL  EDUCATION  IN  ELEMENTARY   SCHOOLS      415 

lated  with  mental  states  of  the  "courage  type"  and  flexor 
positions  with  mental  states  of  the  "fear  type,"  the  former 
should  be  emphasized.  Body  movements  and  positions  im- 
press their  qualities  upon  the  mind.  It  is  equally  important 
to  develop  motor  facihty  for  the  purpose  of  expressing  men- 
tal states.  Training  in  "impression"  and  "expression"  are 
therefore  potent  modes  of  mental  development  and  have  a 
large  place  in  physical  training. 

Hygienic  Exercises. — Purpose. — The  organic  effects  of  ex- 
ercise are:  (i)  the  stimulation  of  the  vaso-motor  system  and 
the  heart  and  lungs,  (2)  organic  massage,  and  (3)  a  general  ex- 
ercise of  the  muscles  leading  to  their  normal  tone  and  develop- 
ment. For  this  purpose  large  movements  of  large  muscles 
are  used.  Exercises  should  be  simple  and  well  known,  so  that 
no  time  is  lost  in  learning  them.  They  should  be  given  to 
rhythmic  serial  count,  and  not  to  response  commands,  for 
the  latter  involve  static  contraction  and  loss  of  time.  The 
teacher  should  aim  for  amphtude  rather  than  accuracy,  and 
should  emphasize  extensor  positions.  The  greatest  attention 
should  be  given  to  exercises  of  the  trunk.  Next  in  order  of 
importance  are  flexion  and  extension  of  the  thighs,  using  the 
body  weight  as  a  load.  Under  this  section  should  be  placed 
training  in  athletics  and  the  practise  of  folk-dances  of  the 
simple  running  type  consisting  of  many  repetitions  of  large 
simple  movements. 

Recreative  Exercises. — Recreative  exercises  have  two 
phases — teaching  and  practise.  They  must  be  carefully 
taught  and  thoroughly  learned,  for  not  until  they  become 
the  possession  of  the  child  and  the  expression  of  his  unthink- 
ing pleasure  in  activity  do  they  become  most  useful  as 
recreation.  Teaching  is  subjective  and  practise  objective, 
and  the  latter  attitude  should  be  obtained  as  soon  as  possible. 
For  this  reason  comparatively  few  forms  of  recreative  exer- 
cises are  to  be  taught.  It  is  better  to  know  a  few  games  well 
and  enjoy  them  than  to  know  many  and  continually  think  of 
the  rules. 


41 6  EDUCATIONAL   HYGIENE 

Games. — A  carefully  graded  series  of  games  has  been  es- 
tablished, beginning  in  the  lower  grades  with  the  traditional 
singing  games  and  proceeding  through  the  individual  running 
and  chase  series  to  the  highly  organized  competitive  team 
games. 

They  provide  (i)  hygienic  exercise,  (2)  neuromuscular 
education,  (3)  social  and  ethical  training,  (4)  recreation.  In 
the  selection  of  games  for  physical-training  purposes  each 
function  should  be  considered  with  reference  to  (i)  adminis- 
trative necessities,  (2)  other  forms  of  physical  training  used, 
(3)  the  stage  of  mental  and  physical  development  of  the  chil- 
dren, (4)  the  social  necessities  of  the  group. 

Folk-Dances. — These  are  dances  which  have  been  handed 
down  from  generation  to  generation,  preserving  their  form  and 
rhythm  with  but  little  modification.  They  present  various 
forms,  i.  e.  (i)  simple  singing  games  with  or  without  a  dra- 
matic content,  (2)  dramatic  dances,  describing  a  vocation, 
etc.,  (3)  festival  dances,  (4)  contra-dances,  (5)  dances  of  solo, 
couple,  and  quadrille  formations.  Folk-dances  should  be  dis- 
tinguished from  (i)  social  dances  which  sometimes  develop 
from  them,  (2)  fancy  steps  and  gymnastic  dances  which  are 
devised  for  hygienic  or  educational  purposes,  and  (3)  esthetic 
dances  which  seek  to  develop  expression  or  impression  of  an 
artistic  nature,  and  (4)  theatrical  dances  which  are  mainly 
for  display.  Folk-dances  should  be  chosen  with  reference  to 
their  (i)  authenticity,  (2)  dosage  of  exercise,  (3)  simplicity  and 
ease  of  administration,  (4)  appropriateness  to  psychological 
and  physiological  development,  (5)  social  and  ethical  elements. 

Mimetic  Exercises. — In  the  lowest  grades  exercises  in- 
volving imitation  of  simple  motor  activities  should  be  intro- 
duced, as  blowing  up  paper  bags,  scooping  sand,  imitating 
the  wind  blowing  through  the  trees,  and  the  like.  These 
may  be  organized  into  gymnastic  stories  in  which  the  teacher 
relates  an  interesting  story  and  the  children  dramatize  its 
various  features.  Typical  of  these  is  the  "Fireman's  Story," 
"A  Walk  in  the  Woods,"  "Snowball  Play." 


t4 


PHYSICAL   EDUCATION   IN   ELEMENTARY    SCHOOLS      417 

Athletics. — Athletics  are  natural  forms  of  exercise  which 
are  practised  in  spontaneous  competition.  The  fundamental 
movements  in  athletics  are  running,  jumping,  climbing, 
swimming,  and  throwing,  all  of  which  have  been  of  the  great- 
est importance  to  the  human  race  in  its  struggle  for  survival. 
For  this  reason  there  is  an  instinctive  desire  to  excel  in  these 
exercises,  coupled  with  a  desire  to  prove  superiority.  Inas- 
much as  these  are  old  racial  movements,  they  have  impressed 
themselves  upon  human  structure,  and  we  find  the  bodies  of 
children  fitted  for  their  practise  and  dependent  upon  it  for 
their  orderly  development.  In  prescribing  these  and  other 
natural  forms  of  exercise,  it  is  necessary  for  us  to  follow  the 
principle:  determine  what  children  would  naturally  do  under 
normal  conditions  and  replace  the  practise  of  these  movements 
in  their  lives  which  otherwise  would  be  abnormal.  The 
fundamental  movements  of  athletics  are  taught  in  the  lower 
grades  as  gymnastic  exercises  and  play.  Following  the  phys- 
ical and  social  development  of  the  child,  a  series  of  athletic 
events  and  their  derivatives  in  the  forms  of  athletic  games 
has  been  devised  and  applied  to  elementary  schools.  Thus 
the  instruction  in  gymnastics  serves  to  prepare  the  way  for 
a  more  free  indulgence  in  athletics  and  athletic  games. 

Organized  Athletics. — Athletics  are  useful  on  account  of 
their  motivation  for  good  hygiene,  neuromuscular  education, 
and  the  social  intermingling  of  children  engaged  in  natural 
exercise.  There  are  two  types,  the  intensive  and  the  exten- 
sive. The  former  is  the  natural  outgrowth  of  the  compet- 
itive instinct.  It  results  in  the  selection  of  the  best  runner 
and  jumper  to  represent  his  school  in  large  athletic  meets. 
The  hygienic  and  educational  benefit  is  thus  frequently  re- 
stricted to  the  children  who  need  it  least.  The  social  results, 
however,  are  important,  for  a  large  number  of  boys  become 
acquainted  with  athletics  and  are  stimulated  to  train.  The 
focussing  of  interest  of  the  student  body  upon  the  maintenance 
of  school  prestige  and  honor  is  a  constructive  and  solidifying, 
socializing  force.     Intensive  athletics  are  a  necessity  prelimi- 


41 8  EDUCATIONAL   HYGIENE 

nary  to  the  introduction  of  extensive  athletics,  in  which  all 
boys  may  take  part.  Of  this  type  there  are  two  forms,  com- 
petition against  standards  and  group  competitions.  The 
athletic  badge  test  of  the  New  York  City  schools  provides  a 
series  of  standards  which  nearly  every  boy  can  attain  by 
consistent  practise.  If  he  passes  his  test  he  is  given  a  smaH 
bronze  or  silver  badge  bearing  the  figure  of  the  Winged. 
Victory.  Fifty  thousand  of  these  badges  have  been  dis- 
tributed by  the  Board  of  Education  of  New  York  City. 
The  tests  are  as  follows: 

ATHLETIC  BADGE  TEST  IN  THE  ELEMENTARY  SCHOOLS 

The  Athletic  Badge  Test  may  be  held  at  any  time  during  the  year. 

The  names  of  successful  boys  should  be  sent  to  the  office  of  the 
Public  Schools  Athletic  League,  not  later  than  May  ist.  During  the 
month  of  May  the  official  test  will  be  held. 

Standards 

Class  A. — Bronze  Badge 

60  Yards  Dash 83-5  seconds 

Pull-up  (chinning  on  bar) 4  times 

Standing  Broad  Jump 5  feet  9  inches 

Class  B. — Bronze  Silver  Badge 

60  Yards  Dash,  indoors 8  seconds 

(or)  100  Yards  Dash,  outdoors 14  seconds 

Pull-up  (chinning) 6  times 

Standing  Broad  Jump 6  feet  6  inches 

Note. — All  age,  weight,  or  height  classifications  are  disregarded  ^:ii 
the  Athletic  Badge  Test  and  boys  are  given  a  Class  A  or  Class  ^^ 
badge  according  to  their  qualifications. 

Conditions 

Only  those  boys  shall  be  admitted  to  the  Athletic  Badge  Test 
who  received  a  mark  of  at  least  "B"  for  the  month  previous  in  effort, 
proficiency,  and  deportment,  and  who  arz  making  satisfactory  effort  to 
secure  good  posture. 


PHYSICAL   EDUCATION   IN   ELEMENTARY    SCHOOLS      419 

In  order  to  win  a  badge  a  boy  must  qualify  in  all  three  events  in 
his  class. 

Winners  of  last  year's  badges  are  not  debarred  from  competition. 

Rules 

The  following  general  rules  shall  govern  the  final  competition : 
There  shall  be  but  one  trial  chinning,  one  in  the  dashes,  and  three  in 
the  jumps. 

Sixty  Yards  Dash  and  One  Hundred  Yards  Dash. — The  general  rules 
of  competition,  as  set  forth  in  the  P.  S.  A.  L.  Handbook,  shall  govern 
this  test,  except  there  shall  be  no  finals. 

Chinning. — The  boy  shall  extend  himself  to  his  full  length  before 
and  after  each  pull-up,  and  shall  be  obliged  to  raise  his  body  without  a 
kick,  snap,  jerk,  or  swing  to  such  a  height  as  to  bring  his  chin  higher 
than  the  bar. 

Jumping. — The  rules  of  the  P.  S.  A.  L.,  as  set  forth  in  the  Hand- 
book, Rules  XXV  and  XXVII,  shall  govern  this  test,  except  that,  as 
there  is  no  real  contest,  i.  e.,  there  is  no  striving  for  first,  second,  or 
third  place,  the  finals  shall  be  dispensed  with. 

The  Winthrop  Trophy  will  be  awarded  for  one  year  to  the  school 
that  qualifies  for  the  Athletic  Badge  and  highest  percentage  of  its 
enrolled  grammar  boys  (fifth,  sixth,  seventh,  and  eighth  year  pupils). 
A  Silk  Banner  will  be  presented  to  the  school  in  each  borough  having 
the  highest  percentage  of  enrolled  pupils  qualifying.  Boys  below  the 
fifth  year  may  compete  for  the  Athletic  Badge  but  are  not  to  be  counted 
in  determining  the  school's  percentage.  The  school  reporting  the 
highest  percentage  in  Athletic  Badge  competition  will  be  ofiicially 
tested,  and  if  the  percentage  attained  at  the  official  test  is  still  higher 
than  any  other  reported  percentage,  the  school  will  be  awarded  the 
trophy.  If,  however,  in  the  official  test  the  school  falls  below  other 
reported  percentages  these  other  schools  will  be  tested  in  the  orde'  of 
their  standing  until  a  school  is  found  whose  official  percentage  Is 
higher  than  any  other  reported  percentage. 

Each  school  is  expected  to  conduct  its  own  tests.  If  assistance  is 
required,  application  should  be  made  to  the  secretary  of  the  P.  S.  A.  L. 

Badges  can  be  secured  only  through  the  Supply  Department  of 
the  Board  of  Education.  Requisition  for  the  same  is  to  be  made  in 
the  usual  manner. 

Public  Schools  Athletic  League, 

157  East  67th  Street,  New  York  City. 

Typical  of  the  group  competitions  is  class  athletics,  in 
which  there  are   three   seasons:   for  running,  jumping,  and 


420  EDUCATIONAL   HYGIENE 

chinning.  The  whole  class  trains  and  endeavors  to  improve 
in  performance,  so  that  the  average  record  of  the  class  will 
compare  favorably  with  all  other  classes  of  a  similar  grade, 
and  possibly  obtain  the  coveted  prize.  In  New  York  City 
over  sixty  thousand  boys  regularly  enter  these  tests, 

(Bulletin  for  boys'  grammar  classes) 

CLASS  ATHLETICS 
Athletics  for  All  the  Boys 

In  this  form  of  athletics  a  record  is  made  by  the  whole  class  in- 
stead of  by  an  individual. 

At  least  80  per  cent  of  the  boys  enrolled  in  the  class  must  take 
part  in  order  to  have  the  record  stand. 

The  number  taking  part  must  not  be  less  than  twelve. 

Trophies  to  be  held  one  year  will  be  awarded  in  each  borough  by 
the  Public  Schools  Athletic  League  to  the  fifth,  sixth,  seventh,  and 
eighth  year  classes  for  the  best  Class  Records  made  in  each  of  the 
following  events: 

Standing  broad  jump Tested  in  the  fall 

Pull-up,  or  "chinning" Tested  in  the  winter 

Running Tested  in  the  spring 

(Distances  for  running:  fifth  year,  40  yards;  sixth  year,  50  yards; 
seventh  year,  60  yards;  eighth  year,  80  yards.) 
Classes  may  be  tested  as  follows: 

Standing  Broad  Jump 

The  best  record  made  in  three  trial  jumps  is  taken  for  each  boy. 
The  class  record  is  determined  by  adding  the  individual  records  and 
dividing  the  total  by  the  number  of  boys  competing.  Jumping  must 
be  done  from  a  line.  Schools  not  provided  with  a  jumping-mat  should 
take  steps  to  obtain  one. 

Pull-up 

The  boy  shall  extend  himself  to  his  full  length  before  and  after 
each  pull-up,  and  shall  be  obliged  to  raise  his  body,  without  a  kick, 
snap,  jerk,  or  swing,  to  such  a  height  as  to  bring  his  chin  higher  than 
the  bar. 


PHYSICAL   EDUCATION   IN   ELEMENTARY   SCHOOLS      42 1 


Running 

In  order  to  lessen  the  possibility  of  error  in  timing  the  competitors, 
the  following  method  has  been  adopted:  The  boys  are  hned  up  behind 
the  starting-mark  in  the  order  in  which  they  are  to  run;  the  timer, 
who  also  acts  as  starter,  stands  at  the  finish  line  and  gives  the  signal 
for  each  boy  to  start.  As  the  first  runner  crosses  the  finish  hne  the 
second  runner  is  given  the  signal  to  start.  As  the  last  boy  crosses  the 
finish  line  the  watch  is  stopped.  The  record  is  found  by  dividing  the 
time  elapsed  by  the  number  of  boys  competing.  If  an  ordinary  watch 
is  used,  the  first  boy  should  be  started  when  the  second  hand  is  over 
the  "60"  mark. 

Blanks  will  be  furnished  for  reporting  the  tests,  which  are  to  be 
sent  in  as  follows: 

Standing  broad  jump On  or  before  December  i 

Pull-up On  or  before  March  15 

Running On  or  before  May  15 

Each  school  is  expected  to  conduct  its  own  tests. 

All  boys  are  considered  eligible  for  Class  Athletics,  subject  to  the 
approval  of  the  Principal. 

When  the  records  are  all  in,  the  three  classes  in  each  borough 
having  the  best  records  for  their  grade  wiU  be  tested  officially.  If  a 
record  is  then  made  better  than  any  other  record  sent  in,  the  trophy 
will  be  awarded  to  the  class  making  it.  If,  however,  the  records  made 
at  the  official  test  are  lower  than  other  reported  records,  the  classes 
will  be  tested  in  order  until  a  record  is  made  at  an  official  test  that  is 
higher  than  any  other  reported  or  official  record. 

The  trophies  are  perpetual.  They  are  in  the  form  of  a  shield, 
with  bronze  plates  for  engraving  the  names  of  schools  that  win  them 
from  time  to  time.  These  trophies  are  offered  for  competition  once 
each  year. 

This  form  of  athletics  is  especially  desirable,  as  it  gives  every 
boy  an  opportunity  to  take  part,  and  the  size  of  the  school  does  not 
in  any  way  affect  the  chances  of  winning  a  trophy. 

The  boys  should  practise  by  themselves  in  the  yard,  on  the  street, 
at  home,  or  elsewhere,  prior  to  the  tests. 

Frequent  preliminary  tests  are  recommended. 

Dr.  C.  Ward  Craiipton,  Secretary, 
Public  Schools  Athletic  League, 

157  East  67th  Street,  New  York  City. 


422  EDUCATIONAL  HYGIENE 

The  full  development  of  athletics  involves  the  careful 
management  of  its  intensive  and  extensive  forms,  the  holding 
of  city,  district,  and  school  championships,  and  the  extension 
of  training  facilities  to  the  utmost  administrative  limit.  In 
New  York  City  163  school  playgrounds  have  been  opened 
for  after-school  athletic  practise  and  forty  thousand  boys 
practise  regularly  every  day. 

Athletics  for  Girls. — Girls  are  recognized  as  different 
physically,  mentally,  and  socially  from  boys  during  their 
elementary  school  course.  They  are  also  to  be  prepared 
during  the  period  of  youth  for  an  entirely  different  adoles- 
cent and  adult  life.  Boys  have  a  racially-old  instinct  for 
vigorous  competition  which  girls,  in  a  measure,  lack.  Girls 
are  more  normally  interested  in  rhythmic  exercise,  particularly 
dancing.  There  is  an  equal  need  of  general  exercise  and  of 
out-of-door  play.  The  most  appropriate  form  of  group  exer- 
cise for  girls  is  folk-dancing,  on  account  of  its  instinctive  ap- 
peal, its  happy  content  of  music  and  rhythm,  its  development 
of  a  social  consciousness,  and  its  economy  of  administration. 
In  addition  it  must  be  realized  that  girls  desire  to  indulge  in 
athletic  play  and  should  do  so.  For  this  purpose  games  have 
been  adopted  and  devised  which  give  much  interesting  and 
valuable  exercise. 

In  the  elementary  schools,  athletics  for  girls  have  been 
developed  during  the  after-school  time.  Clubs  are  formed  and 
practise  weekly  in  folk-dancing,  relay  races  (shuttle,  potato, 
all-up,  hurdle,  pass-ball),  basket-ball  throw  for  distance,  and 
various  team  games  including  endball,  captain-ball,  basket- 
ball, and  punchball,  the  last  a  modification  of  the  baseball. 
In  addition  the  clubs  are  taken  upon  walking  excursions. 
A  system  of  rewards  has  been  devised  whereby  the  girl  who 
attends  a  certain  number  of  sessions  of  the  club  will  receive 
an  athletic  badge.  Competitions  between  clubs  take  place 
at  the  end  of  the  season  and  the  girls  of  the  club  obtaining 
the  victory  are  given  badges  of  another  form.  The  emphasis 
of  this  procedure  is  based  upon  the  successful  performance 


PHYSICAL  EDUCATION   IN   ELEMENTARY   SCHOOLS      423 

of  a  certain  amount  of  exercise  and  less  upon  competition 
against  others  or  against  standards  which  are  characteristic 
of  athletics  for  boys.  In  conducting  athletics  for  girls  it  is 
necessary  to  guard  against  a  prostitution  of  the  activity  into 
a  mere  training  for  an  exhibition.  It  is  important  that  ex- 
hibitions of  folk-dancing  and  athletics  for  girls  should  not  be 
permitted  for  unselected  audiences;  and  exhibitions  to  which 
the  public  may  pay  to  attend  should  be  avoided.  Indi- 
vidual competition  and  individual  exhibition  should  be  wholly 
eliminated.  It  is  advisable  also  that  special  costumes  of  an 
expensive  nature  should  not  be  required;  and  all  forms  of 
interschool  competition  should  be  discouraged.  The  follow- 
ing rules  have  been  adopted  by  the  girls'  branch  of  the  Public 
Schools  Athletic  League: 

ATHLETIC  RULES  FOR  ELEMENTARY  SCHOOLS 

Rule  I.     Athletic  Membership 

The  Girls'  Branch  recognizes  as  athletic  members  all  public-school 
girls  members  of  elementary  schools  who  belong  to  girls'  athletic 
clubs  registered  in  the  League. 

Rule  II.     Eligibility  (Girls) 

(a)  Athletic  membership  is  open  only  to  girls  from  the  third  to 
the  eighth  school  year,  inclusive. 

(b)  Eligibility  for  membership  in  clubs  is  left  to  the  discretion 
of  the  principal,  with  the  one  proviso  that  a  physician's  statement 
be  secured  in  cases  of  doubtful  physical  fitness. 

But 

(c)  Any  girl  to  be  eligible  to  compete  in  the  contests  conducted 
under  the  auspices  of  the  Girls'  Branch  or  to  win  any  of  its  athletic 
pins  must  meet  all  of  the  following  requirements: 

(i)  The  girl  must  have  been  in  the  school  at  least  one  month. 

(2)  She  must  be  a  member  of  a  club  that  has  fulfilled  the  require- 
ments for  amount  of  work  done. 

(3)  She  must  have  taken  part  in  active  practise  of  at  least  twenty 
sessions  of  her  club. 


424  EDUCATIONAL   HYGIENE 

(4)  She  must  have  a  standing  in  school  work  of  B  in  effort,  deport- 
ment, proficiency,  and  posture  at  the  time  of  the  meet  or  at  the  time 
of  the  completion  of  her  season  of  all-round  athletics. 

Rule  III.     Eligibility  (Clubs) 

In  order  that  the  members  may  be  eligible  to  take  part  in  contests 
or  win  athletic  pins,  a  club  must 

(a)  Register  with  the  Executive  Secretary  of  the  Girls'  Branch, 
Public  Schools  Athletic  League,  157  East  67th  Street  (on  blanks  fur- 
nished by  the  League),  not  later  than  November  i,  and  begin  practise 
not  later  than  November  i. 

(b)  Hold  at  least  twenty-four  practise  meetings  during  the  school 
year. 

(c)  Keep  a  record  of  the  season's  practise  on  blanks  furnished  by 
the  League.     (This  applies  only  to  "all-round  athletic"  practise.) 

{d)  Practise  only  such  folk-dances,  games,  and  other  athletics  as 
are  sanctioned  by  the  Girls'  Branch. 

Rule  IV.     Winning  of  Athletic  Pins 

I.  All-round  athletics  (blue-and-silver  AU-Round  Athletic  Pins 
won  by  individuals  on  season's  record,  irrespective  of  competition). 

II.  School  interclub  contests  (bronze  Winged  Victory  pins,  won 
by  members  of  club-winning  contest). 

Note. — It  is  possible  to  win  both  pins  in  one  year  if  the  require- 
ments for  each  are  fulfilled. 

I.     All-Round  Athletics 

(for  blue-and-silver  All-Round  Athletic  Pin) 

General  Requirements 

(a)  Eligibility. — To  win  an  all-round  athletic  pin  a  girl  must  be 
eligible  according  to  Rule  II,  Article  c. 

(b)  Required  Attendance.— Stho.  must  have  actively  participated  in 
at  least  twenty  athletic  meetings  of  a  club  which  is  eligible,  according  to 
Rule  III,  Article  a,  and  which  has  fulfilled  the  following  requirements: 

Specific  Requirements 

(c)  Club  Meetings. — The  club  must  hold  at  least  twenty-four 
active  athletic  meetings  during  the  school  year. 

{d)  Outdoor  Practise. — At  least  eight  of  these  twenty-four  meetings 
must  be  out-of-doors  (a  greater  proportion  of  time  out-of-doors  is 
strongly  recommended  wherever  it  is  possible). 


J 


PHYSICAL   EDUCATION   IN   ELEMENTARY    SCHOOLS      425 

(e)  Required  Record  for  Ail-Round  Athletics. — The  sancUoncd  ele- 
mentary school  athletic  activities  are  classified  in  four  groups  as  follows: 

Group  I.   Walking        1 

Swimming     }  any  or  alL 

Ice  skating  J 
Group  2.    Folk-dances  approved  by  the  League. 


Group  3.    Captain-ball 
End-ball 
Basket-ball 
Punch-ball 

Group  4.   Pass-ball  relay 
All-up  relay 
Shuttle  relay 
Potato  relay 
Hurdle  relay 
Basket-ball  throw 


any  or  all. 


four  or  more. 


It  is  required  that  a  club  select  at  least  three  of  these  groups  and 
during  the  season  devote  an  equal  amount  of  time  to  the  practise  of 
each  of  the  chosen  groups.  This  rule  is  hard  and  fast,  with  one  excep- 
tion, which  is  that,  at  the  discretion  of  the  principal,  sessions  of  activities 
belonging  to  Group  2,  3,  or  4  may  be  substituted  for  some  of  the 
sessions  under  Group  i,  provided  that  there  be  a  minimum  of  five 
actual  walks  or  swims  for  which  nothing  else  is  substituted.  In  other 
words,  if  a  club  had  selected  all  four  groups  for  all-round  athletic 
practise,  six  sessions  of  each  group  would  then  be  necessary.  In  this 
case  it  would  be  allowable  for  one  session  of  games,  dancing,  or  relays 
to  be  substituted  for  one  of  the  walking  or  swimming  sessions.  If  a 
club  had  selected  but  three  groups,  then  eight  sessions  of  each  group 
would  be  necessary.  In  this  case  it  would  be  allowable  for  three 
sessions  of  games,  dancing,  or  relays  to  be  substituted  for  three  of  the 
walking  or  swimming  sessions. 

(/)  Certified  Official  Record  Sheet. — An  official  record  of  a  club's 
all-round  athletic  practise  must  be  kept  on  an  official  blank  furnished 
by  the  League  and  must  show  that  it  has  completed  the  required 
record.  This  is  signed  by  the  principal  and  teacher  in  charge,  and  is 
sent  in  at  the  completion  of  the  season's  practise  to  the  Executive 
Secretary  of  the  Girls'  Branch,  together  with  a 

(g)  Certified  List  of  Eligible  Candidates. — This  list  is  on  the  reverse 
side  of  the  record  sheet  and  should  contain  the  names  of  all  members 
of  the  club  who  have  attended  at  least  twenty  sessions  of  the  club 
and  who  have  met  all  requirements  as  to  eligibility.  (Rule  II,  Ar- 
ticle c.) 


426  EDUCATIONAL  HYGIENE 

(h)  Pins. — To  secure  the  all-round  athletic  pins,  it  is  absolutely 
necessary  for  the  principal  to  take  the  following  steps  immediately 
after  the  completion  of  the  season's  record: 

(i)  Send  the  official  record  of  all-round  athletics,  together  with 
the  certified  list  of  eligible  candidates,  to  the  Executive  Secretary  of 
the  Girls'  Branch. 

(2)  At  the  same  time  send  in  to  the  Director  of  Physical  Training, 
157  East  67th  Street,  a  requisition  for  "All-round  Athletic  Pins"  on 
the  regular  school-supply  blank  (first  having  it  signed  by  the  district 
superintendent),  together  with  its  duplicate,  calling  for  a  number 
sufficient  for  the  eligible  candidates,  including  the  teacher  or  teachers 
who  have  had  active  charge  of  the  club's  practise. 

II.     School  Interclub  Contests 
(for  Bronze  Winged  Victory  Pins) 

(a)  Place. — All  contests  shall  be  held  in  the  school  building  or 
grounds,  except  in  case  there  be  no  suitable  place  or  when  held  in 
connection  with  a  school  Field  Day.  In  order  to  secure  a  place  for 
the  purpose  other  than  the  school  premises,  it  is  necessary  to  secure 
the  approval  of  both  the  district  superintendent  and  the  Girls' 
Branch. 

(b)  Date. — Notice  of  the  proposed  date  for  a  contest  shall  be  sent 
to  the  Executive  Secretary  of  the  Girls'  Branch,  Public  Schools  Ath- 
letic League,  157  East  67th  Street,  at  least  three  weeks  in  advance. 
No  contest  shall  be  held  earlier  than  3.45  P.  M.  unless  by  special 
permission. 

(c)  All  competitions  shall  be  between  clubs,  classes,  or  teams  of 
one  school.     No  interschool  competition  is  allowed  in  girls'  athletics. 

{d)  All  competitions  shall  be  between  groups,  and  there  shall  be 
no  competition  between  individuals. 

{e)  Eligibility. — All  clubs  and  members  of  clubs  must  be  eligible. 
(Rule  II,  Article  c;  Rule  III,  Articles  a,  b,  d.) 

if)  Programme. — The  competition  numbers  in  the  programme 
shall  consist  of  at  least  four  of  the  athletic  events  sanctioned  for 
elementary  schools,  and  folk-dancing.  Every  club  entered  in  the  con- 
test shall  take  part  in  each  athletic  event,  and  each  club  shall  dance 
two  folk-dances,  one  of  these  to  be  an  individual  one,  i.  e.,  a  different 
one  from  those  danced  by  the  other  clubs,  the  other  a  common  dance, 
i.  e.,  one  that  is  danced  by  all  the  clubs  as  a  basis  of  comparison  by 
the  judges. 


PHYSICAL   EDUCATION   IN   ELEMENTARY    SCHOOLS      427 

(g)  Chief  Judge. — A  chief  judge  (officially  assigned  through  the 
League)  shall  be  in  charge  of  the  contest.  It  shall  be  the  duty  of  the 
chief  judge  to  decide  all  questions  relating  to  the  actual  conduct  of 
the  contest  whose  final  settlement  is  not  otherwise  covered  by  these 
rules.  This  judge  shall  assign  the  assistant  judges  and  inspectors  to 
duty  and  shall  be  responsible  for  the  conduct  of  the  contest.  The 
decision  of  the  chief  judge  is  final  and  without  appeal. 

(h)  Other  Officials. — A  school  shall  supply  in  advance  two  assistant 
judges  and  three  inspectors  to  act  under  the  chief  judge.  These  officials 
may  be  from  the  teaching  force,  but  not  of  the  school  conducting  the 
meet. 

(i)  Score. — The  official  score  shall  be  kept  by  the  chief  judge. 
This  score-card,  containing  the  official  score,  the  name  of  the  winning 
club  (exactly  as  it  should  be  engraved  on  the  trophy  or  appear  on  the 
records),  the  principal's  signature  of  approval  as  to  eligibility,  and  the 
official  report  and  signature  of  the  chief  judge,  shall  be  returned  by 
the  chief  judge  immediately  after  the  contest  to  the  Executive  Secre- 
tary of  the  Girls'  Branch. 

(/)  Marking  Grounds. — The  floor  should  be  plainly  and  accurately 
marked  for  all  events  before  the  hour  of  the  meet.  These  marks  should 
include  all  bases  and  goal  lines  for  the  team  games,  starting-lines  for 
the  relay  races,  circles  for  the  All-up  Relay  when  that  is  used,  or  lines 
and  circle  for  the  basket-ball  distance  throw  should  that  be  on  the  pro- 
gramme. 

(k)  Costume. — No  special  or  fancy  costumes  for  dances  are  al- 
lowable. (Gymnasium  suits  and  shoes  are  strongly  urged,  but  are  not 
obligatory.  Gymnasium  shoes  with  ordinary  dress  are  recommended 
in  case  gymnasium  suits  are  not  obtainable.) 

(I)  Good  Sportsmanship. — All  games  should  be  conducted  strictly 
in  accordance  with  the  rules  for  them  specified  in  this  handbook. 
Players  should  be  instructed  prior  to  a  meet  on  the  points  of  good  sports- 
manship, which  should  include  especially  how  to  lose  with  good  spirit; 
never  to  question  the  decision  of  an  official;  to  cheer  for  a  defeated  op- 
ponent; and  to  play  a  game  for  the  game's  sake  rather  than  to  win  at 
all  costs. 

{m)  Pins  and  Trophy. — When  the  winning  team  is  announced  at 
the  close  of  the  contest  by  the  chief  judge,  bronze  Winged  Victory  pins 
shall  be  awarded,  one  to  each  member  of  the  winning  team  and  one  to 
each  teacher  who  has  had  active  charge  of  the  competing  clubs  during 
the  season's  practise.  If  the  school  has  a  trophy  for  girls'  athletics 
it  shall  be  awarded  to  the  winning  team  to  be  held  by  them  until  the 
contest  the  following  year.. 


428 


EDUCATIONAL   HYGIENE 


Time  for  Physical  Training. — The  following  time  is  given 
in  New  York  City  schools: 


First 

year 

minutes 

Second 

year 
minutes 

Third 

year 

minutes 

Fourth 

year 
minutes 

Fifth 

year 

minutes 

Sixth 

year 

minutes 

Seventh 

year 
minutes 

Eighth 

year 
minutes 

Physical  train- 
ing, recesses, 
physiology, 
and  hygiene 

^00-450 

180-210 

180-210 

150-180 

90-120 

90-120 

80-120 

80-120 

In  the  three  lower  grades  recesses  are  called  for,  and  these 
are  carefully  organized  according  to  the  following  plan: 


(i)  Recesses  should  be  taken  out-of-doors  unless  lack  of  space  or 
bad  weather  absolutely  prohibits. 

(2)  Every  opportunity  for  exercise  should  be  improved.  Children 
should  run  or  skip  to  their  places  instead  of  marching.  Standing  in 
line  should  be  reduced  to  a  minimum.  Children  may  be  dismissed 
by  squads  to  attend  the  toilet;  those  awaiting  their  turn  should  mean- 
while engage  in  play. 

(3)  Each  child  should  be  encouraged  to  take  a  drink  of  water. 

(4)  Play  should  be  vigorous.  The  games  chosen  should  insure 
each  child's  taking  active  part.  There  should  be  at  least  one  min- 
ute's running  in  each  recess. 

(5)  If  the  indoor  playground  is  used,  the  temperature  should  range 
from  60  to  65  degrees.  Windows  and  doors  should  be  opened  to  pro- 
vide sufficient  fresh  air  unless  the  outdoor  temperature  is  very  low. 
Too  little  ventilation  and  too  high  temperatures  are  most  serious  evils 
and  should  be  carefully  guarded  against. 

(6)  If  the  play  raises  any  dust  it  should  be  stopped  at  once  and 
the  children  should  return  to  their  classrooms.  The  principal  should 
be  informed  and  the  recess  taken  at  another  time,  after  the  playground 
has  been  cleaned. 

(7)  In  the  use  of  the  singing  game: 

(a)  It  should  not  occupy  more  than  one-half  of  the  playing  time. 

(b)  Not  more  than  one  singing  game  should  be  used  in  a  recess. 

(c)  Too  frequent  repetition  in  the  same  game  should  be  avoided- 

(d)  Only  one  singing  game  should  be  in  progress  at  one  time. 

(e)  The  song  element  of  the  game  may  be  taught  in  the  classroom. 
(/)    The  song  should  be  carefully  pitched  within  the  proper  range 

of  voice,  and  for  this  purpose  the  pitch-pipe  should  be  used.     Special 


PHYSICAL   EDUCATION   IN   ELEMENTARY   SCHOOLS      429 

atlention  should  be  given  to  singing  softly  and  to  proper  enunciation. 
The  special  teachers  of  music  will  assist  the  teachers  as  to  the  proper 
manner  of  singing.  The  singing  should  make  appropriate  use  of  the 
head  voice,  and  chest  tones  should  be  avoided.  If  there  is  a  tendency 
to  become  out  of  breath,  the  children  may  sing  alternately  by  groups 
or  classes. 

(8)  The  programme  for  the  recess  should  be  varied  to  avoid 
monotony.  It  may  well  contain  a  game,  a  song  play,  and  a  simple 
folk-dance.  It  is  more  important  that  a  few  games  or  dances  should 
be  thoroughly  learned  and  enjoyed  than  to  become  acquainted  with 
many  forms  of  play. 

The  following  tests  should  be  applied  to  all  play  procedure: 

(a)  Are  all  the  children  actively  engaged  more  than  half  the  time? 

(b)  Are  they  happy? 

(c)  May  the  play  be  stopped  and  quiet  attention  obtained  instan- 
taneously upon  signal  from  the  teacher  in  charge? 


In  the  lower  grades  the  time  is  broken  up  into  short 
periods  of  ten  to  twenty  minutes,  for  folk-dancing,  gymnastic 
stories,  gymnastic  games,  recesses,  and  formal  gymnastics. 
In  addition  to  the  above  time,  every  child  in  all  grades  has  a 
two-minute  drill  at  10,  11,  and  2  o'clock,  with  the  windows  of 
the  classroom  wide  open. 

THE  TWO-MINUTE  DRILL 

Grades  from  3-A  to  8-B  inclusive 

Monitors  open  windows  without  command. 
Class. — Stand.     (Face  windows  without  command.) 
(i)  Breathing — four  times.     In — out.     (Six  seconds  for  inhalation, 
four  for  exhalation — -do  not  hold  breath.)     Right  or  left — face. 

(2)  Relaxing  and  stretching — four  times.  Relax  (with  arms  and 
back  relaxed,  bend  the  trunk  forward).  Stretch  (straighten  the  body 
and  arms  upward;  stretch  to  fullest  extent).  Down  (turn  hands  and 
bring  arms  down  to  sides  quickly,  without  noise). 

(3)  Knee  bending  and  stretching — eight  times.  (Thumbs  locked 
behind  without  command.)  Down — up  (must  be  done  quickly  to  get 
hygienic  result).     Right  or  left — face. 

(4)  Breathing — four  times  (same  as  above).     In — out. 
Class. — Sit. 


430  EDUCATIONAL   HYGIENE 

This  type  of  exercise  is  very  much  more  beneficial  where 
teachers  get  it  done,  not  as  a  dead,  perfunctory  task,  but  as 
a  joyous,  exhilarating  opportunity. 

Organization. — In  a  large  city  a  department  should  be 
organized  as  follows: 

Director  of  hygiene. 

Assistant  directors  of  physical  training. 

Assistant  directors  of  educational  hygiene. 

Division  of  medical  inspection. 

Inspectors  of  athletics  for  boys. 

Inspectors  of  athletics  for  girls. 

Special  teachers  of  physical  training  (district  supervisors, 
elementary  schools). 

Special  teachers  of  physical  training  (high  and  training 
schools) . 

Local  supervisors  of  physical  training  (elementary  schools). 

The  directors  and  assistants  should  be  highly  qualified 
with  reference  to  their  particular  work.  Each  special  teacher 
should  be  assigned  to  the  supervision  of  four  hundred  class 
teachers,  to  visit  them  as  often  as  possible,  to  advise,  direct, 
and  inspire  their  work.  They  should  pass  an  examination  on 
the  theory  and  practise  of  physical  training,  and  should  pre- 
sent evidence  of  high-school  and  normal-school  (physical 
training)  graduation.  They  should  be  employed  for  one 
year  as  substitutes,  and  then  if  found  satisfactory  receive 
an  annual  license  for  three  years,  after  which  time  the 
license  may  be  made  permanent.  A  special  teacher  should 
visit  the  class  teacher,  observe  her  work,  make  corrections, 
and  teach  the  required  new  exercises.  She  should  make  a 
memorandum  of  the  results  of  her  observations  and  leave  a 
written  series  of  suggestions  to  the  class  teacher,  retaining 
a  carbon  as  an  official  permanent  record.  The  following 
form  is  used  in  the  New  York  City  schools: 


i 


PHYSICAL   EDUCATION   IN   ELEMENTARY    SCHOOLS 


431 


DEPARTMENT  OF  EDU- 
CATION,   CITY   OF 
NEW   YORK 

SPECIAL  TEACHER'S   MEMORANDUM 

P.  S.  No. 

Boro. 

SYLLABUS    GYMNASTICS 

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SUGGESTIONS   TO   CLASS 

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At  the  end  of  the  term  the  special  teacher  makes  out  the 
record  shown  on  pages  432  and  433  for  each  school. 

It  is  necessary  to  support  the  work  of  the  special  teacher 
by  a  system  of  local  supervision.  This  requires  that  the  prin- 
cipal, assistant  principal,  or  other  assistant  in  the  school 
itself  shall  be  charged  with  the  duty  of  visiting  and  supervis- 
ing the  work  in  all  classes  in  the  interval  of  the  special  teacher's 
visit.  The  special  teacher  always  confers  with  the  local  super- 
visor upon  entering  the  school.  She  receives  a  report  of  the 
work  and  a  request  to  visit  certain  teachers  in  special  need  of 
assistance.  The  local  supervisor,  in  so  far  as  possible,  should 
accompany  the  special  teacher  on  her  visit.  At  the  end  of 
the  day  the  special  teacher  again  confers  with  the  local 
supervisor,  suggesting  methods  of  procedure.     Inasmuch  as 


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EDUCATIONAL  HYGIENE 


the  local  supervisors  are  not  technically  trained,  the  follow- 
ing suggestions  are  appropriate: 


SUGGESTIONS    TO    LOCAL    SUPERVISORS    OF    PHYSICAL 
TRAINING   AND   CLASS  TEACHERS 

What  to  See  in  the  Classrooms 

General:  Has  the  teacher  a  syllabus? 

Is  she  giving  the  lesson  for  the  week? 
Does  she  know  exercises? 
Do  monitors  open  windows? 
60  to  68  degrees  Fahrenheit. 


Ventilation : 
Temperature : 
Standing  up  and  taking 

distance : 
Posture : 

Stretching: 


Breathing  : 

Marching : 

Facing:  Lower  Grades. 
Other  Grades: 

Formal  Exercises : 


Alertness. 

Attention  to  posture  at  beginning  of  lesson. 

Head— Chest— Weight. 

Cues  and  urging  for  posture. 

Is  good  posture  obtained? 

Individual  correction. 

Face  windows. 

Urging  by  cues. 

Are  lungs  filled  ?  chest  lifted  ? 

Is  posture  improved? 

Do  pupils  know  what  to  do? 

Accuracy,  military  alertness,  brisk  time. 

Drill  on  direction. 

Do  the  children  know  right  from  left? 

Alertness,  accuracy. 

Is  facing  done  sharply  and  by  all  in  time? 

Is  good  posture  maintained? 

Does  teacher  know  exercise? 

Do  pupils  know  exercise? 

Are  response  commands  maintained  with  proper 

pause  ? 
Do  they  become  rhythmical? 
Docs  class  go  ahead  of  teacher? 
Is  there  speed  and  accuracy? 
Are  terminal  positions  emphasized? 
Is  good  posture  obtained?  to  fullest  extent? 
Are  descriptive  urging  commands  (cues)  used? 
Are  positions  which  will  correct  poor  posture 

emphasized  ? 


PHYSICAL   EDUCATION   IN   ELEMENTARY   SCHOOLS 


435 


Whole  Lessons: 


Classroom  Games : 


Two-Minute  Drill: 


Marking : 


Does  teacher  know  the  purpose  of  emphasizing 
these  positions  ? 

Are  individuals  corrected? 

Do  pupils  gain  in  alertness?  In  knowledge  of 
exercise  ? 

Is  there  a  tone  of  pleasure  to  the  lesson  and  a 
pride  in  good  performance? 

Has  there  been  sufficient  "exercise"? 

Has  a  game  been  used  ? 

Does  teacher  understand  corrective,  hygienic, 
and  educational  results  of  exercise  and  how 
they  should  be  obtained? 

Are  they  used  in  every  lesson? 

Do  all  children  know  them? 

Do  teachers  get  results  from  games,  i.  e.,  "ex- 
ercise," pleasure,  and  relaxation  (hygienic)  ? 
sense  training,  alertness,  motor  training  (edu- 
cational) ? 

Is  it  given  twice  in  A.  M.,  once  in  p.  M.,  or  be- 
tween every  two  periods  (unless  one  of  these 
is  devoted  to  physical  training)  ? 

Does  teacher  know  what  it  is  for?  (Relief 
from  sitting,  corrective,  hygienic.) 

Does  each  exercise  produce  its  appropriate  re- 
sult? 

Are  all  pupils  marked  on  physical  training? 

Are  all  pupils  working  for  improvement  ? 


From  time  to  time  conferences  for  instruction  of  local 
supervisors  should  be  called,  and  regular  monthly  meetings 
should  be  held  for  all  supervisory  teachers  of  physical  train- 
ing. Thus  it  will  be  seen  that  there  are  two  methods  of  ad- 
ministering the  physical- training  work: 

First:  A  specially  quaUfied  teacher  actually  instructing 
the  pupils  in  that  which  is  appropriate  to  high  and  training 
schools. 

Second :  Instruction  given  to  pupils  by  the  ordinary  class 
teacher  under  occasional  supervision. 

The  teaching  of  pupils  directly  by  experts  is  increasing  in 
vogue.  Provisions  should  be  made  for  the  special  training  of 
class  teachers  who,  in  grade  schools,  may  be  assigned  under 


436  EDUCATIONAL   HYGIENE 

the  departmental  system  to  teach  physical  training  for  full 
time.  To  qualify  for  this  position  at  least  120  hours'  special 
training  in  a  normal  school  should  be  required. 

Special  Classes 

Physical  Training  for  the  Deaf. — Children  who  are  deaf 
should  be  taught  by  the  use  of  lip-reading.  To  render  this 
effective,  the  pupil's  eyes  must  be  carefully  examined  and 
all  defects  corrected.  This  is  exceedingly  important  because 
eye  defects  among  deaf  children  are  very  common;  and  their 
vision  is  of  greater  importance  to  them  than  to  those  who 
have  normal  hearing.  These  children  are  deficient  in  co-or- 
dination; they  lack  a  sense  of  balance  and  are  slow,  inac- 
curate, and  frequently  devoid  of  a  sense  of  rhythm.  They 
respond  readily  to  proper  methods  of  work,  and  the  greatest 
possible  benefit  may  be  derived  from  physical  training. 

Blind. — These  children  usually  suffer  from  inactivity,  be- 
cause they  are  afraid  to  move  about.  They  are  sadly  in 
need  of  physical  training  of  every  type,  particularly  games 
and  other  forms  of  happy  recreation.  They  should  be  taught 
in  accordance  with  the  proper  and  appropriate  method  for 
normal  children.  They  do  well  in  athletics  if  they  are  prop- 
erly protected  from  harm.  They  may  engage  in  short  races  if 
lines  of  cord  are  stretched  elbow-high  along  the  lanes.  Games 
may  be  played  within  a  circle  roped  off  from  contact  with 
walls  or  hard  objects.     Bells  may  be  attached  to  these  ropes. 

Crippled. — -Children  may  be  crippled  by  infantile  paralysis, 
bone-and- joint  disease,  or  by  injury  to  the  central  nervous 
system.  In  spite  of  their  disability,  they  are  still  children 
much  in  need  of  the  educational,  hygienic,  and  recreational 
benefits  of  physical  training,  and  should  receive  the  same. 

Great  caution  should  be  exercised  in  handhng  children 
who  have  had  tuberculosis,  for  overexercise  or  injury  may 
revive  the  disease;  and  those  who  have  active  lesions  are 
usually  more  in  need  of  rest  than  exercise. 


PHYSICAL   EDUCATION   IN  ELEMENTARY   SCHOOLS      437 

Care  must  also  be  taken  in  giving  exercise  to  children 
with  one  set  of  muscles  paralyzed,  for  overdevelopment  of  the 
antagonistic  muscles  may  increase  the  deformity.  Each  case 
must  be  considered  separately  and  a  physician's  advice  ob- 
tained and  followed  with  care.  The  following  cards  may  be 
filled  out  for  each  child: 

Front 

DEPARTMENT  OF  EDUCATION— CITY  OF  NEW  YORK 

Record  Card  for  Crippled  Children 

Name Born 

FAMILY  GIVEN 

Address  No Street Floor  No 

Name  of  teacher 

School ,  Borough Date  entered Class 

Recommendations  for  Physical  Training 


I  For  improving  posture 
For  alert  response — control. 
For  physiological  results 

{Seat  games 
Quiet  games 
Active  playground  games. . . 


Exercises  contra-indicated . 


Back 
Name  of  Pupil Date 

FAMILY  GIVEN 

Hospital Physician 

Diagnosis 

Treatment — Mechanical  appliances 

Should  the  child  be  in  a  hospital  ? 

If  not,  is    he  physically  able  to  attend  school? 

Should     he  be  placed  in  a  class  with  physically  normal  children  ? . 

Is  the  disease  active  at  present  ? 

Should     he  be  permitted  to  climb  stairs? No.  flights 

Chorea Cardiac  disease Vision 

Breathing Hearing 


438  EDUCATIONAL  HYGIENE 

Conclusion. — The  most  favorable  plan  of  organization  for 
elementary  schools  is  that  indicated  above,  where  the  allied 
varieties  of  work  for  health  and  recreation  are  under  a  single 
head  responsible  to  the  superintendent  of  schools.  The  in- 
terrelations of  physical  training,  hygiene,  medical  inspection, 
afterschool  playgrounds,  folk-dancing,  and  athletic  clubs  are 
numerous  and  important.  If  administered  together  as  an 
integral  whole,  they  support  each  other.  If  administered 
separately,  they  cannot  fail  to  increase  the  difficulty  of 
management  and  unavoidable  errors  in  adjustment.  Physical 
training  is  an  important  and  growing  subject.  Introduced 
under  specialists  engaged  as  experts  to  teach  the  children,  it 
has  become  an  integral  part  of  the  educational  system  of 
the  country.  The  laggard,  least-developed  field  is  that  of 
the  rural  schools,  which  probably  need  it  most. 


CHAPTER  XXIII 

PHYSICAL   EDUCATION  AND   ATHLETICS   IN  THE 
HIGH   SCHOOLS 

The  Physical  Status  of  the  High-School  Student.— The 
period  now  given  over  to  high-school  study  was,  in  the  early 
years  of  the  development  of  the  human  race,  devoted  to  the 
learning  of  the  practical  affairs  of  life  with  the  incidental 
acquisition  of  physical  strength  and  endurance.  Along  with 
these  went  the  development  of  moral  powers  and  physical 
courage,  subjective  and  objective  neuromuscular  control  and 
co-ordination,  and  many  other  quaUties,  but  always  in  im- 
mediate unconsciousness  of  self.  The  change  wrought  by 
modern  civilization  has  altered  all  this.  To  be  sure,  a  certain 
variable  amount  of  motor  activity  is  required  of  every  boy  or 
girl  of  high-school  age  in  the  ordinary  routine  of  home  and 
school  hfe.  While  the  need  of  a  fine  physique  and  great 
physical  endurance  is  not  so  apparent  at  present  as  in  primi- 
tive days,  nevertheless  we  are  learning  more  and  more  that 
true  culture  of  the  highest  type  depends  to-day  no  less  than  in 
the  early  years  of  evolution  upon  doing  things  that  correspond 
in  type  to  the  worthy  deeds  of  the  race. 

The  motor  activity  at  present  required  oi  the  average 
high-school  boy  or  girl  in  the  usual  daily  routine  is  not  suffi- 
cient to  provide  for  his  physical,  moral,  social,  and  intel- 
lectual needs,  and  it  becomes  the  function  of  the  department 
of  physical  education  to  provide  that  "margin  of  motor  ac- 
tivity" necessary  for  the  best  intellectual,  moral,  social,  and 
physical  development  not  otherwise  provided  for  in  the 
school  or  home. 

The  quantity  and  quality  of  this  needed  margin  of  motor 

439 


440  EDUCATIONAL   HYGIENE 

activity  which  belongs  to  the  high  school  cannot  accurately 
be  determined,  for  it  will  of  necessity  vary  with  the  individual, 
as  well  as  with  the  course  of  study  offered  in  various  schools 
and  the  section  of  the  country.  It  is  evident  that  the  boy  or 
girl  who  comes  from  the  farm  each  day  to  attend  the  school 
and  returns  to  his  home  at  the  end  of  the  school-day  will  not 
need  the  same  kind  or  the  same  amount  of  motor  activity  to 
satisfy  this  margin  as  the  boy  or  girl  whose  life  is  lived  in  the 
large  city.  The  question  from  this  point  of  view  becomes 
largely  an  individual  one.  On  the  other  hand,  the  increased 
demand  made  by  the  newer  education  for  motor  activity  in 
connection  with  manual  training,  nature  study,  and  industrial 
training  of  one  kind  or  another  tends  to  decrease  the  quantity 
and  vary  the  quality  of  the  work  of  physical  education.  In 
every  case,  however,  the  fundamental  principles  determining 
the  scope  and  content  of  the  work  required  will  be  the  same, 
for  they  must  of  necessity  rest  upon  the  principles  of  physi- 
ology, anatomy,  psychology,  and  education. 

Ends  to  be  Sought  in  Physical  Education. — The  question 
naturally  arises  as  to  what  ends  should  be  sought  in  the 
"margin  of  motor  activity"  which  is  to  be  supplied  by  the 
high  school.  If  the  ends  are  kept  clearly  in  mind  by  the 
teachers  of  physical  education,  as  well  as  by  the  other  in- 
structors, the  ways  to  the  ends  may  be  followed  with  greater 
accuracy.  Unfortunately,  the  great  majority  of  physical  ed- 
ucators have  thought  of  physical  education  as  a  problem 
detached  from  general  education.  On  the  other  hand,  general 
educators  have  stopped  their  studies  of  physical  education, 
for  the  most  part,  with  the  details  of  school  management.  As 
a  result,  the  greater  portion  of  the  work  of  physical  education 
in  high  schools  has  been  directed  to  no  definite  ends  and  has 
been  determined  by  the  whim  or  previous  training  of  the 
teachers. 

The  following  ends  should  certainly  be  kept  in  mind. 
Which  ones  should  be  sought  most  must  be  determined  by 
the  teacher  after  a  careful  study  of  the  needs  of  the  pupils. 


PHYSICAL  EDUCATION   IN  HIGH   SCHOOLS  44 1 

I.  Health. — It  is  the  business  of  the  department  of  phys- 
ical education  to  secure  for  the  individual  pupil  certain  con- 
ditions of  health,  such  as  good  posture  and  organic  vigor  of 
the  various  organs,  which  can  come  only  with  a  rational 
distribution  of  motor  activities.  This  may  be  accomplished 
only  when  there  is  a  close  co-operation  between  the  depart- 
ment of  physical  education  and  the  department  of  medical 
supervision.  Without  a  more  or  less  complete  medical  exam- 
ination, physical  education,  from  the  standpoint  of  health  and 
bodily  resistance,  has  no  foundation  on  which  to  build.  The 
hygienic  end  should  be  placed  first  and  must  always  be  kept  in 
mind,  for  it  limits  in  many  ways  the  attainment  of  the  other 
ends  of  physical  education.  In  other  words,  physical  educa- 
tion should  always,  in  the  highest  degree,  be  hygienic,  not  only 
for  the  typical  pupil  but  for  each  indi\ddual  pupil.  It  can  be 
made  so  only,  as  has  already  been  said,  on  the  basis  of  knowl- 
edge of  the  health  conditions  of  each  pupil;  for  many  students, 
both  boys  and  girls,  are  being  injured  yearly,  for  example,  by 
participation  in  athletics  and  other  exercises  which  are  too 
severe  for  them  with  their  peculiar  organic  or  functional  weak- 
nesses. While  at  times  the  striving  for  these  qualities  of 
health  may  be  the  main  or  sole  end  of  physical  education,  it 
is  much  more  desirable  that  other  ends  be  sought  which  make 
certain  the  acquisition  of  these  health  qualities  as  a  by-prod- 
uct. It  is  important  that  the  pupils  find  some  other  inter- 
est in  the  training  they  receive  than  the  primary  subjective 
interest  of  keeping  healthy.  There  should  be  some  objective 
interest  in  these  motor  activities  which  should  enlist  the  in- 
terest and  enthusiasm  of  the  pupil  and  draw  his  attention 
away  from  himself. 

Health  or  medical  supervision  of  high-school  pupils  may 
be  placed  quite  largely  in  the  hands  of  teachers  of  physical 
training  if  the  latter  are  trained  for  the  work.  Preferably  they 
should  have  medical  knowledge. 

2.  The  Development  of  Certain  Moral  and  Social  Qualities. 
—Physical  education  in  the  high  schools,  if  properly  admin- 


442  EDUCATIONAL  HYGIENE 

istered,  will  contribute  very  largely  to  the  development  of 
physical  and  moral  courage,  the  acquisition  of  will  power, 
and  the  determination  to  accomplish  in  face  of  obstacles.  In 
addition,  self-control,  self-reliance,  the  ability  to  co-operate 
with  others,  respect  for  the  rights  of  others,  self-sacrifice,  the 
submission  to  the  will  of  another  or  the  group,  and  many 
other  such  qualities,  should  be  developed  by  boys  and  girls 
in  their  associations  in  the  gymnasium  and  athletic  field. 
Probably  very  little  profitable  instruction  in  theoretical 
ethics  can  be  given  in  the  liigh  schools,  and  the  pupils  must 
absorb  by  actual  living  most  of  their  moral  instruction;  and 
the  gymnasium  and  the  athletic  field  afford  superior  oppor- 
tunities to  both  boys  and  girls  for  the  learning  of  great  moral 
lessons.  The  able  instructor  in  physical  education  probably 
has  a  greater  opportunity  to  influence  the  moral  tone  of  the 
students  than  the  teacher  of  any  other  subject.  It  is  impor- 
tant, therefore,  that  this  teacher  have  a  clear  appreciation  of 
the  moral  influence  that  he  should  exert,  and  that  he  possess 
the  personality  and  character  necessary  to  exert  such  in- 
fluence wisely  and  effectively.  The  department  of  physical 
education  that  fails  to  appreciate  the  great  possibility  that  it 
has  for  education  along  these  lines,  and  fails  to  work  for  these 
results,  neglects  an  opportunity  that  cannot  be  met  by  any 
other  feature  of  school  life. 

3.  The  Development  of  Certain  Intellecttial  Qualities. — • 
The  "margin  of  motor  activity"  belonging  to  physical  edu- 
cation should  tend  to  the  development  of  subjective  and  ob- 
jective control,  quickness  and  alertness,  self-knowledge,  con- 
fidence in  one's  ability  and  the  ability  to  think  quickly  in 
times  of  crisis,  a  better  sense  of  posture,  and  better  neuro- 
muscular control  throughout  the  whole  organism  resulting  in 
ability  to  express  to  some  extent  feelings  and  emotions  through 
physical  movement. 

The  attainment  of  these  ends  of  physical  education  rests  upon 
the  following  agencies,  which  should  be  at  the  command  of  every 
hi^h  school: 


PHYSICAL  EDUCATION   IN  HIGH   SCHOOLS  443 

I.  Manual  and  Industrial  Training. — Of  course,  manual 
and  industrial  training  stands  for  other  things  than  physical 
education,  but  it  may  contribute,  and  usually  does,  to  this  end. 
It  furnishes  a  needed  change  from  the  purely  mental  to  phys- 
ical employment  and  brings  about  a  greater  co-ordination  be- 
tween hand  and  mind.  When  it  involves  the  use  of  the  larger 
groups  of  biologically  old  muscles,  such  as  is  frequent  in  forge 
work  and  the  heavier  forms  of  carpentry  and  metal  work,  it 
stimulates  respiration  and  circulation  and  tends  to  a  healthier 
state  of  the  vegetative  organs  throughout  the  body.  As  such 
it  represents  types  of  motor  activity  that  are  hygienic,  recre- 
ative, and  educational. 

II.  Gymnastics. — Undoubtedly,  better  results  will  be  ob- 
tained if  conditions  make  possible  the  carrying  on  of  all  the 
motor  activities  of  physical  education  out-of-doors.  This  is 
obviously  impossible  with  climatic  conditions  as  variable  as 
they  are  in  a  large  portion  of  the  United  States  and  with 
local  conditions  imposing  such  serious  limitations  as  to  equip- 
ment as  is  often  the  case.  The  gymnasium,  therefore,  becomes 
necessary  for  the  proper  and  complete  development  of  phys- 
ical education  in  probably  the  large  majority  of  high  schools. 
Even  with  the  best  of  outdoor  fields  and  equipment,  too,  the 
gymnasium  is  an  extremely  desirable  adjunct.  There  can  be 
no  question  that,  when  pupils  have  reached  the  high-school 
age,  girls  and  boys  should  be  taught  in  separate  gymnasium 
classes.  This  is  necessary  not  only  because  of  the  social 
questions  involved,  but  because  gymnastic  exercises  suitable 
for  boys  are  in  general  not  well  suited  to  girls.  Furthermore, 
it  seems  very  doubtful  whether  girls  should  be  instructed  by 
men  teachers  in  the  gymnasium,  for  the  physiological  and 
anatomical  differences  between  girls  and  boys  are  frequently 
too  little  appreciated  by  the  male  teacher  of  gymnastics. 
And  even  the  able  woman  director  may  be  much  lacking  in 
this  respect. 

Unfortunately,  up  to  the  present  time  gymnastics  have 
been  the  one  form  and  often  the  only  form  of  motor  activity 


444  EDUCATIONAL   HYGIENE 

required  of  every  pupil  in  all  schools  in  which  the  work  is 
compulsory  as  fulfilling  the  needs  of  physical  education.  An 
analysis  of  the  results  of  gymnastic  exercises  and  a  comparison 
of  these  results  with  the  results  of  the  other  possible  forms  of 
motor  activity,  in  view  of  the  ends  to  be  sought  in  physical 
education,  will  not  justify  the  undue  emphasis  placed  upon 
them.     The  possible  reason  for  this  emphasis  is  twofold: 

First:  General  education  has  given  but  comparatively 
little  attention  to  the  study  of  physical  education  for  high 
schools.  When  such  study  has  been  undertaken  it  has  stopped 
usually  with  the  details  of  school  management.  From  the 
view-point  of  school  administration,  gymnastics  offer  the  easi- 
est solution  to  the  question  of  what  the  scope  and  conduct  of 
physical  education  should  be,  for  a  single  teacher  without  much 
effort  can  control  a  class  of  one  hundred  boys  or  girls,  can  give 
them  exercises  which  are  to  some  extent  hygienic,  corrective, 
and  mildly  educative,  and  which  at  the  same  time  will  appeal 
to  the  onlooker  who  is  ignorant  of  the  underlying  aims  of 
physical  education  as  being  exceedingly  worth  while.  Here 
admirable  form  and  perfect  school  machinery  may  be  any- 
thing but  the  means  for  contributing  to  all-round  physical 
education. 

Second :  The  great  majority  of  teachers  of  physical  educa- 
tion have  been  narrowly  trained  and  are  often  ignorant  of  the 
general  principles  and  tendencies  of  hygiene  and  education. 
They  think  of  physical  education  as  a  detached  problem,  un- 
related to  the  other  aspects  of  education.  With  them  health 
as  typified  by  large  muscles  and  the  ability  to  perform  various 
artificial  "stunts"  on  the  floor  or  the  fixed  apparatus  is  the 
main  if  not  the  only  goal  worth  while.  The  physical  and 
spectacular  aspects  of  physical  education  occupy  their  entire 
thought  and  energies  and  obscure  the  great  moral,  social,  and 
intellectual  ends. 

Reconstruction  of  Formal  Gymnastics. — Formal  gymnas- 
tics need  to  be  reconstructed  to  satisfy  educational  needs  as 
we  now  understand  them.     At  their  best,  as  practised  to-day, 


PHYSICAL  EDUCATION  IN  HIGH   SCHOOLS  445 

formal  gymnastics  are  hygienic  and  contribute  largely  to  a 
healthy  condition  of  the  organism,  but  only  when  the  larger, 
fundamental,  or  biologically  old  groups  of  muscles  are  called 
into  action.  Such  motor  activities  can  be  graded  to  meet  the 
physical  limitations  of  every  individual.  They  quicken  the 
respiration  and  circulation  and  result  in  increased  tone  and 
functioning  of  the  various  organs.  On  the  other  hand,  these 
results  can  be  more  perfectly  secured  through  other  forms  of 
motor  activity  without  the  accompanying  objectionable  fea- 
tures. Unfortunately,  the  larger  part  of  the  gymnastic  hour 
in  many  cases  is  devoted  to  the  practise  of  exercises  involving 
smaller  groups  of  muscles  which  result  in  the  bringing  about 
of  a  great  many  artificial  co-ordinations  and  which,  while  only 
to  a  slight  degree  hygienic,  are  mentally  fatiguing. 

Formal  gymnastics  when  carried  on  with  the  individual 
or  a  small  group  may  be  made  corrective.  Probably  no  other 
form  of  motor  activity  made  use  of  in  physical  education  is 
so  largely  so.  When  carried  on  with  large  classes  the  results 
are  not  so  satisfactory.  To  secure  corrective  results  from  such 
exercises  the  pupil  must  be  urged  to  concentrate  his  attention 
upon  his  muscular  system  so  that  he  may  assume  with  the 
greatest  of  accuracy  certain  unnatural  postures.  These  exer- 
cises are  uninteresting,  and  it  requires  a  teacher  with  an  unu- 
sual personality  to  secure  results  along  this  line  that  are  at 
all  striking.  Very  often,  unless  great  care  is  taken,  the  exer- 
cises are  executed  in  such  a  way  as  to  further  increase  the  de- 
formity which  they  are  intended  to  correct. 

Furthermore,  as  a  corrective  agent  formal,  corrective, 
orthopedic,  or  medical  gymnastics  should  correspond  to  drugs 
in  medical  practise.  Normal  individuals  do  not  need  drugs, 
nor  does  the  normal  high-school  boy  or  girl  need  special  cor- 
rective gymnastic  exercises.  As  education  from  kindergarten 
up  becomes  more  hygienic,  gymnastics  as  a  corrective  agent 
will  not  have  to  be  used.  This  does  not  mean  that  formal 
gymnastic  exercises  should  be  executed  with  no  regard  to 
good  posture,  for  this  is  not  the  case,  but  it  does  mean  that 


446  EDUCATIONAL   HYGIENE 

those  exercises  which  are  simply  corrective  and  have  no  other 
justification  should  largely  be  dropped  from  the  gymnastic 
course.  More  and  more  we  are  learning  that  perfect  sym- 
metry of  development  at  all  ages  is  not  to  be  expected.  The 
inequality  of  growth  of  one  side  of  the  body  may  produce  a 
slight  deformity  at  one  time  which  will  be  corrected  within  a 
short  time  by  a  compensatory  growth  of  the  other  side.  The 
majority  of  adults  normally  have  one  shoulder  higher  than  the 
other,  a  slight  curve  of  the  spine,  or  some  other  slight  de- 
formity. In  the  vast  majority  of  such  cases  the  cause  of  these 
deformities  cannot  be  removed  by  corrective  gymnastics.  It 
is  only  when  these  deformities  become,  or  tend  to  become, 
pathologic  that  any  particular  form  of  corrective  gymnastics 
needs  to  be  applied.  Under  any  well-directed  system  of  all- 
round  exercise  these  slight  deformities  will  not  appear  or  will 
tend  to  correct  themselves. 

Formal  gymnastics  tend  to  develop  exact  subjective 
control  and  increase  the  powers  of  co-ordination  and,  to  some 
extent,  the  ability  to  co-operate,  while  the  introduction  of 
certain  forms  of  apparatus  work  improves  objective  control 
and  makes  a  demand  upon  physical  courage.  In  this  respect 
they  are  intellectually,  morally,  and  socially  beneficial.  These 
ends,  however,  with  the  exception  of  subject  control,  can  be 
more  promptly  attained  on  the  playground  or  athletic  field. 

There  are  serious  objections  to  formal  gymnastics  as  now 
practised;  for  while  they  contribute  to  the  hygienic  needs  of 
the  pupil,  in  doing  so  they  make  health  the  primary  end  in- 
stead of  holding  up  some  objective  end  which  will  hold  the 
interest  of  the  pupils  and  produce  health  as  a  by-product. 
They  are  artificial  and  formal  in  every  way  and  do  not  cor- 
respond in  type  to  the  various  primitive  motor  activities  of 
the  race.  They  are  mechanical,  lacking  mental  content;  they 
are  jerky  and  awkward  as  compared  with  natural,  useful 
movements  and  involve  the  consciousness  of  muscle  and  body 
by  the  pupil.  They  are  uninteresting  and  cultivate  a  dislike 
for  healthful  exercise.  In  short,  they  are  not  means  to  the 
satisfaction  of  normal  life-purposes. 


PHYSICAL   EDUCATION   IN   HIGH   SCHOOLS  447 

So  much  cannot  be  said  against  all  forms  of  apparatus 
work,  for  in  this  there  is  frequently  an  objective  interest 
which  relieves  the  monotony.  Great  care,  however,  must  be 
exercised  in  selecting  these  exercises  for  girls  of  high-school 
age.  There  is  a  frequent  tendency  to  teach  girls  apparatus 
exercises  which  are  too  strenuous  for  them.  For  adolescent 
girls,  jumping  exercises  and  swinging  by  the  arms  should  be 
carefully  limited. 

III.  Dancing. — Undoubtedly,  this  form  of  motor  activity 
should  make  up  a  considerable  part  of  the  physical  activities 
required  of  girls  in  the  gymnasium,  but  only  a  Kmited  part  of 
that  required  of  boys.  By  some  authorities  dancing  is  con- 
sidered the  best  of  all  forms  of  exercise  for  girls.  Through  the 
revival  of  folk-dancing  during  the  last  few  years,  it  has  come 
more  and  more  into  prominence  as  a  necessary  part  of  the 
training  of  physical  education.  The  dances  should  be  se- 
lected with  care.  They  may  be  correlated  often  with  the  work 
of  the  school  and  the  seasonal  interests,  such  as  Christmas 
celebrations,  patriotic  anniversaries,  and  pageants.  Dances 
may  and  should  be  used  as  a  form  of  expression  of  worthy 
feelings  and  emotions.  This  they  may  do  without  losing  any 
of  their  hygienic  and  recreative  values.  Dancing  cultivates, 
in  addition,  gracefulness,  subjective  control,  and  a  keen  sense 
of  rhythm.  The  dances  do  not  appeal  to  boys,  and  it  is  doubt- 
ful whether  any  great  amount  of  time  spent  on  them  is  worth 
while,  for  the  same  results  for  the  most  part  may  be  secured 
through  other  forms  of  activity.  This  does  not  mean,  of 
course,  that  such  instruction  cannot  be  motivated  as  a  prep- 
aration for  social  dancing  where  the  young  men  and  women 
dance  together. 

IV.  Games  and  Athletics.-  -Under  a  well-planned  system 
of  physical  education,  games  and  athletics  for  both  boys  and 
girls  will  not  only  provide  for  the  average  individual  but  will 
provide  in  the  best  way  all  the  motor  activity  needed  to  satisfy 
that  margin  which  physical  education  must  supply.  When 
properly  regulated  and  applied,  there  is  no  aim  of  physical 
education  which  thev  do  not  meet  better  than  any  other  form 


448  EDUCATIONAL  HYGIENE 

of  activity.  The  movements  of  play  athletics  are  natural 
and  represent  types  of  exercises  which  have  been  prominent 
in  the  development  of  the  race.  They  are  hygienic  to  a  degree 
that  the  other  forms  of  exercise  mentioned  above  usually  are 
not;  but  it  is  in  the  development  of  those  more  prominent 
intellectual,  moral,  and  social  qualities  which  we  aim  to  at- 
tain that  they  surpass  all  others.  Many  of  the  movements 
of  athletes,  moreover,  are  directly  corrective  in  their  results. 
Some  have  no  direct  corrective  value,  while  others,  on  the 
other  hand,  undoubtedly  tend  to  increase  such  defects  as 
round  shoulders,  low  shoulders,  lateral  curvature,  and  the  like. 

Unfortunately,  valuable  as  are  games  and  athletics,  they 
have  not  had  a  wide  use,  both  for  the  lack  of  equipment  nec- 
essary to  make  them  available  to  all  and  because  their  pos- 
sibilities even  with  little  equipment  have  not  been  carefully 
worked  out.  As  a  result  athletics  have,  at  best,  been  used  to 
contribute  to  the  training  of  a  few  special  athletes,  both  boys 
and  girls,  who  make  the  school  teams,  and  these  are  quite 
commonly  the  pupils  who  need  this  particular  training  least. 

The  number  of  games  available  for  use  in  the  high  school 
is  very  large.  The  list  given  below  is  by  no  means  exhaustive, 
being  merely  suggestive  of  the  types  of  games  that  are  avail- 
able. A  careful  analysis  of  the  results  of  any  of  these  games 
will  probably  show  that  they  meet  all  the  principal  require- 
ments of  physical  education  in  that  they  are  hygienic  and 
may  be  made  to  contribute  to  the  intellectual,  moral,  and 
social  education  of  those  taking  part  in  them: 

FOR   BOYS  .  FOR   GIRLS 

Baseball.  Indoor  baseball. 

Basket-ball.  Basket-ball  (girls'  rules). 

Field  hockey.  Field  hockey. 

Ice  hockey.  Handball. 

Cricket.  Swimming  and  diving. 

Lacrosse.  Fifty-yard  dash. 

Soccer.  Hurdle  races. 

Football.  Tennis. 

Handball.  Volley-ball. 

Volley-ball.  Centre-ball. 


National  dances,  playground  festival,  public  schools,  Hackensack,  N.  J. 


By  permission  of  the  Bureau  of  Education,  Manila,  P.  I. 

The  girls'  basket-ball  team  from  Iloilo,  P.  I.     Champions  of  the  Visayan 
Islands,  19 14 


i 


PHYSICAL  EDUCATION   IN   HIGH   SCHOOLS  449 


FOR   BOYS 

FOR   GIRLS 

Centre-ball. 

Golf. 

Boxing. 

Track  and  field  athletics. 

Squash. 

Tennis. 

Bowling. 
Dodge-ball. 

Bowling. 
Swimming. 

Methods. — Having  discussed  briefly  the  aim  of  physical 
education  and  the  agencies  at  hand,  we  now  come  to  the  ques- 
tion of  how  these  agencies  may  best  be  applied  to  realize 
these  aims.  In  other  words,  we  must  now  consider  the 
methods.  While  many  questions  connected  with  the  aims 
and  agencies  of  physical  education  from  a  practical  view-point 
still  remain  unsettled,  more  problems  arise  in  connection  with 
the  subject  of  method  than  with  the  other  two.  All  of  these 
problems,  however,  cannot  be  discussed  in  a  chapter  of  this 
nature,  and  many  do  not  at  present  admit  of  a  satisfactory 
solution. 

Shall  the  practise  of  physical  education  in  the  high  school 
be  required  or  be  made  optional  for  the  individual  student? 
Shall  the  work  of  physical  education  be  made  a  recognized 
part  of  the  regular  school  curriculum  as  contributing  to  the 
essential  education  of  every  pupil  and  as  such  be  placed  on  the 
same  plane  as  other  branches  of  instruction  and  be  required 
for  promotion  and  graduation?  If  it  is  required  for  promo- 
tion, what  shall  be  the  standard  by  which  proficiency  in  this 
line  of  work  shall  be  judged?  Shall  the  quaHty  and  quantity 
of  the  work  required  be  the  same  in  all  schools  ?  These  are 
some  of  the  questions  that  are  most  pressing  to-day. 

Answering  the  first  question,  there  seems  Httle  doubt  that 
physical  education  must  be  required  and  cannot  be  made 
optional  if  the  greatest  good  is  to  result.  Otherwise  the  usual 
condition  will  prevail,  that  those  who,  in  the  majority  of  cases, 
need  the  work  most,  refuse  to  elect  it.  We  may  put  it  do^ATi 
as  a  general  principle  that  in  all  exercises  the  qualities  most 
required  for  successfully  carrying  out  the  exercise  are  the 


45°  EDUCATIONAL   HYGIENE 

qualities  which  are  at  length  developed.  The  chances  are 
very  much  in  favor  of  the  belief  that  that  pupil,  boy  or  girl, 
who  lacks  quickness  of  action,  muscular  strength,  endurance, 
power  of  co-ordination,  or  harmonious  development  lacks 
these  quahties  because,  barring  heredity,  he  has  never  engaged 
in  exercises  which  would  produce  them,  and  as  a  rule  he  is 
the  last  one  who  will  avail  himself  of  the  opportunities  offered 
in  the  work  of  physical  education.  Various  attractions  in  the 
past,  such  as  gymnastic  exhibitions  and  "fancy  stunts"  of 
one  kind  or  another,  have  been  used  to  attract  all,  but  they 
have  failed.  There  can  be  no  question  that  the  work  of  phys- 
ical education  must  be  required.  This  requirement  will  be 
much  easier  to  carry  out  if  physical  education  is  made  an 
essential  part  of  the  school  curriculum  and  given  the  same 
dignity  as  the  work  of  the  other  departments,  and  if  a  certain 
degree  of  proficiency  is  required  for  promotion  from  one 
grade  to  another.  Several  objections  to  this  plan  have,  with 
good  reason,  been  urged.  In  the  first  place,  no  definite  out- 
line of  work  has  been  made  up  sufficiently  wide  in  scope  and 
content  to  bear  the  analytical  scrutiny  of  educators  when 
tested  by  the  principles  of  education.  It  is  but  comparatively 
recently  that  modern  psychology  and  physiology  have  made 
known  the  scientific  facts  concerning  the  intimate  interde- 
pendence of  the  different  aspects  of  life  which  are  called 
physical,  intellectual,  and  moral.  Physical  education  is  now 
rapidly  advancing  to  the  point  where  it  will  be  able  to  suggest 
an  outline  of  work  which  is  psychologically  and  physiolog- 
ically sound.  It  will  then  be  pedagogically  acceptable  and 
be  included  as  an  organic  part  of  high-school  education. 
Possibly  this  time  is  even  now  at  hand. 

The  second  objection  raised  is  that  it  is  practically  im- 
possible to  measure  with  any  degree  of  accuracy  many  of  the 
qualities  which  should  be  developed  by  motor  activity. 
How,  for  instance,  are  we  to  estimate  on  a  scale,  say  of  loo 
per  cent,  moral  and  physical  courage,  abihty  to  co-operate, 
willingness  to  sacrifice  oneself  for  the  common  good,  ability 


PHYSICAL   EDUCATION   IN   HIGH    SCHOOLS  45 1 

to  think  clearly  in  times  of  crisis,  and  many  other  such  qual- 
ities which  probably  should  be  the  direct  or  indirect  results 
of  gymnastics  and  athletics  ?  We  have  at  present  no  means 
at  our  command  for  measuring  these  qualities,  but  we  can 
measure  physical  efficiency  as  represented  by  subjective  and 
objective  control,  power  of  co-ordination^  physical  strength, 
etc.,  with  a  fair  degree  of  success. 

For  the  present  at  least  we  can  concentrate  our  attention 
upon  these  qualities  and  not  try  to  measure  the  moral  and 
intellectual  qualities  which  we  may  consider  as  a  by-product. 
In  doing  so  we  are  possibly  in  harmony  with  other  depart- 
ments of  instruction,  such  as  the  department  of  mathematics. 
The  teacher  of  mathematics  tests  his  students  in  the  knowl- 
edge and  use  of  mathematical  formulas,  but  makes  little  at- 
tempt to  test  them  directly  in  some  of  the  leading  qualities 
which  the  study  of  mathematics  is  intended  to  develop. 

The  following  outline  is  suggested  as  a  possible  basis  for 
the  grading  of  students  in  physical  education.  Although 
this  has  been  tried  with  success,  it  is  not  thought  that  it  will 
meet  in  detail  the  needs  of  any  great  number  of  schools,  but 
it  may  suggest  a  possible  method  for  getting  a  fair  estimate  of 
the  physical  efficiency  of  high-school  pupils. 

EXAMINATIONS  AND    CREDITS 

(i)  Term  work  (based  on  attendance,  general  attitude  in 
class,  accuracy  in  the  execution  of  individual  move- 
ments, movements  with  the  class) 30  points 

(2)  Based  on  examinations: 

(a)  Subjective  control,  free  movements,  marching,  etc 30  points 

(b)  Subjective  and  objective  control 40  points 

Swimming 10  points 

Exercises  in  which  the  lower  extremities  are 

principally  used 10  points 

Exercise  in  which  the  body  is  suspended.  .  10  points 
Exercises  in  which  the  body  is  supported  on 

arms 10  points 

Total 100  points 


452  EDUCATIONAL  HYGIENE 

A  similar  plan  may  be  used  in  judging  outdoor  efficiency. 
In  track  events  definite  standards  may  be  set  in  jumping, 
shot-putting,  sprinting,  etc.,  and  pupils  marked  on  their 
ability  to  meet  or  to  exceed  these  standards.  The  grading 
of  work  in  team  games  presents  a  more  difficult  problem  and 
must  rest  largely  upon  the  judgment  of  the  teacher. 

If  a  certain  degree  of  physical  efficiency  is  required  for 
promotion,  the  question  naturally  arises  as  to  what  shall  be 
done  with  the  exceptional  pupil  who  because  of  organic  or 
functional  weakness  is  unable  to  do  the  work  required  of  the 
majority.  It  would  seem  on  the  face  of  it  that  we  ought  not 
to  deprive  him  of  promotion  because  of  physical  defects, 
though  to  be  consistent  with  the  procedure  of  the  other  de- 
partments of  instruction  in  such  cases  there  is  nothing  else 
to  do.  However,  in  the  vast  majority  of  such  cases,  with  in- 
dividual instruction,  work  of  sufficient  scope  can  be  found  to 
justify  such  a  pupil's  promotion. 

Course  of  Study. — It  is  far  easier  to  map  out  a  course  of 
instruction  in  physical  education  that  will  provide  at  least  in 
part  for  the  needs  of  the  pupil  than  it  is  to  carry  out  such  a 
course.  The  course  suggested  below  is  one  which  probably 
cannot  be  carried  out  in  the  average  high  school  but  may, 
however,  serve  as  a  suggestive  arrangement  of  work.  Un- 
doubtedly the  teaching  of  hygiene  should  be  combined  with 
instruction  in  physical  education.  This  is  covered  in  chapter 
XXVI,  to  which  the  reader  is  referred. 

Physical  education  in  the  high  school  should  be  required 
at  least  for  three  periods  a  week  of  one  hour  each. 

In  the  fall  and  spring  all  work  should  be  done  out  of  doors 
on  the  playground  or  athletic  field. 

A  sufficient  number  of  teams  should  be  formed  in  soccer 
football,  baseball,  termis,  lacrosse,  etc.,  to  make  it  possible 
for  every  boy  to  find  a  place;  while  for  girls  field  hockey, 
tennis,  and  out-of-door  basket-ball  should  be  substituted. 
In  addition,  supervision  of  groups  in  volley-ball,  track-and- 
field  events,  centre-ball,  etc.,  for  those  not  prepared  to  enter 
the  more  strenuous  games,  should  be  provided. 


PHYSICAL   EDUCATION   IN  HIGH   SCHOOLS  453 

Such  an  arrangement  of  work  will  require  a  large  athletic 
field  or  playground  conveniently  situated.  In  city  schools 
some  provision  for  out-of-door  work  may  be  provided  for 
through  roof  playgrounds. 

Obviously  one  instructor  Qannot  keep  a  careful  oversight 
of  such  a  variety  of  work,  and  accordingly  other  members  of 
the  teaching  force  should  be  called  upon  to  assist. 

To  one  teacher  may  be  assigned  the  out-of-door  work  of 
one  class.  He,  in  consultation  with  the  head  of  the  depart- 
ment of  physical  education,  should  then  outHne  in  detail  the 
number  of  teams  in  each  branch  of  sport  that  would  be 
necessary  to  provide  for  all  students. 

This  work  will  require  careful  planning  and  attention  to 
many  details,  but  it  pays  richly  for  all  time  spent  on  it. 

Possibly  girls  require  more  careful  supervision  than  boys, 
and  this  supervision  cannot  well  be  given  by  a  man. 

During  the  winter  months  the  work  of  physical  education 
must,  at  least  in  northern  climates,  be  carried  on  indoors. 
Theoretically  every  pupil  should  be  required  to  enter  a  gym- 
nasium class  and  take  part  in  the  class  drills,  dancing,  and  ap- 
paratus work.  Then  those  who  have  shown  by  medical 
examination  that  they  do  not  need  corrective  work  and  are 
organically  sound  should  be  examined  for  co-ordination, 
ability  to  handle  themselves  when  suspended  by  their  arms, 
control  of  body  when  asked  to  balance  in  one  position  or  an- 
other, and  a  combination  of  the  two,  such  as  vaulting.  Those 
showing  marked  proficiency  should  then  be  allowed  to  sub- 
stitute basket-ball,  indoor  baseball,  handball,  manual  train- 
ing, etc.,  for  the  gymnastic  work.  It  is  probable  that  a  vari- 
able amount  of  dancing  should  be  required  of  all  girls. 

Athletics. — The  athletic  management  of  school  teams 
presents  many  difficulties,  most  of  which  can  be  eliminated  by 
placing  the  right  man  in  charge.  Most  of  the  difficulties  in 
boys'  teams  centre  around  the  overwhelming  desire  to  win, 
the  coach,  and  the  expenditure  of  money.  In  the  case  of 
girls,  the  chief  question  is  the  safeguarding  of  health. 


454  EDUCATIONAL   HYGIENE 

It  is  natural  that  boys  of  high-school  age  should  desire  to 
win,  and  this  feeling  should  be  fostered,  but  should  not  be 
made  the  end  of  athletics.  Every  effort  should  be  made  to 
eliminate  the  feeling  that  the  winning  or  losing  of  the  game 
will  make  any  difference  to  the  future  development  of  the 
school  or  the  players.  It  is  the  foolish  feeling  that  the  entire 
future  of  the  school,  State,  and  fatherland  is  to  be  determined 
by  the  result  of  the  game  that  is  responsible  for  much  of  the 
nervous  excitement  that  is  so  detrimental  to  the  best  interest 
of  the  player  and  school.  On  the  other  hand,  it  is  advisable 
to  urge  every  player  as  he  enters  the  game  to  play  up  to  the 
limit  of  his  ability,  whether  winning  or  losing,  but  always,  no 
matter  what  the  provocation,  fairly  and  honestly.  Players 
should  be  made  to  feel  that  they  are  representatives  of  their 
school  and  that  for  the  fair  name  of  the  school  they  should 
gladly  lose  rather  than  resort  to  unfair  or  even  questionable 
tactics  to  win. 

Whether  this  spirit  shall  characterize  a  school's  athletics 
will  be  determined  by  the  coach.  No  matter  what  the  desire 
of  the  principal  and  teachers  may  be  for  athletics,  the  coach 
is  the  person  who  in  the  end  wiU  determine  the  essential 
features  of  the  school's  athletics.  For  this  reason  it  is  quite 
desirable  that  a  regular  teacher,  whose  position  will  not  de- 
pend upon  the  success  of  the  team,  counted  in  the  number  of 
games  won,  become  the  coach.  He,  with  his  wider  view  and 
broader  educational  training,  should  be  able  more  success- 
fully to  guide  the  team  spirit  in  the  right  channel  than  the 
usual  inexperienced  college  graduate  employed  as  coach. 

All  financial  matters  should  also  be  passed  on  by  one  of 
the  teachers.  It  is  a  safe  principle  to  follow  that  no  student 
should  have  any  unsupervised  authority  to  spend  money. 
Here  again  a  call  must  be  made  upon  some  teacher  for  patri- 
otic service.  The  leading  spirit  and  organizer  should  of 
course  be  the  head  of  the  department  of  physical  education, 
and' he  can  assume  some  of  its  responsibilities,  but  he  cannot 
assume  all.     Given  a  sufficient  corps  of  teachers,  the  physical- 


PHYSICAL   EDUCATION   IN   HIGH   SCHOOLS  455 

education  department  is  the  natural  authority  in  all  these 
questions. 

The  great  question  connected  with  girls'  athletic  teams  is 
whether  they  should  be  allowed  to  contend  with  outside 
teams.  There  can  be  no  question  that  girls  as  much  as  boys 
need  to  learn  through  practical  experience  the  "rules  of  fair 
play  and  the  generous  treatment  of  rivals  and  opponents, 
merging  self  in  co-operative  effort,  concentration  of  power, 
and  the  bending  of  all  energies  toward  an  impersonal  ob- 
jective goal."  The  increased  nervous  strain  combined  with 
over  physical  exertion,  however,  renders  doubtful  the  advisa- 
bihty  of  encouraging  girls  to  compete  with  teams  outside  of 
their  own  schools.  Furthermore,  girls  should  not  take  part 
in  vigorous  games  during  the  menstrual  period  and  this  further 
complicates  the  management  of  athletics  for  them.^  With 
study  and  care,  practically  the  same  beneficial  results  with- 
out many  of  the  dangers  may  be  gained  from  intramural 
athletics. 

1  See  Rollings  worth,  L.,  "Functional  Periodicy  in  Women,"  Teachers  Col- 
lege, Columbia  University. 


CHAPTER  XXIV 
PLAY  AND   RECREATION  AT  THE   RURAL   SCHOOL 

Country  Life  and  Physical  Education. — There  are  three 
general  methods  of  physical  education — work,  play,  and  gym- 
nastics. In  the  city,  physical  education  is  mostly  through 
play  and  gymnastics;  in  the  country,  through  work  and  play. 
It  is  impossible  in  these  days  of  swarming  germs  for  any  one 
always  to  dodge  them,  to  run  away  from  them,  or  to  hide 
from  their  presence.  We  cannot  filter  all  the  air  or  sterilize 
all  the  water  or  disinfect  everything  we  touch.  It  is  of  the 
greatest  importance  that  we  should  develop  positive  vital 
resistance  or  in  some  way  prepare  the  body  to  fight  the  germs 
it  cannot  avoid.  But  far  more  important  than  the  avoid- 
ance of  disease  is  the  developing  of  that  positive  side  to  health, 
which  on  the  emotional  side  means  joy  and  vivacity,  on  the 
intellectual  side  means  sanity  and  optimism,  on  the  physical 
side  means  sprightliness  and  the  joy  of  living:  the  sort  of 
thing  that  children  so  often  express  in  their  hippity-hop  as 
they  go  down  the  street.  It  is  essentially  the  spirit  of  play 
vitalizing  the  personality. 

In  the  building  up  of  the  positive  side  of  health,  the  coun- 
try has  certain  advantages:  pure  air,  plenty  of  physical 
activity,  fairly  good  water,  and  an  abundance  of  food.  On 
the  other  hand,  none  of  these  things  are  at  their  best  at  the 
rural  school.  Probably  the  majority  of  rural  schools  have  no 
very  satisfactory  method  of  ventilation;  there  is  much  dust 
from  the  floors  and  blackboards;  the  air  is  seldom  humidified; 
the  water  supply  is  seldom  satisfactory;  and  the  lunch  is 
nearly  always  cold.  If  school  hygiene  is  to  be  on  the  same 
basis  as  other  school  subjects,  however,  it  must  not  be  for  the 
school  alone  but  it  must  establish  habits  and  enthusiasms  that 

456 


PLAY  AND   RECREATION   AT  THE   RURAL   SCHOOL      457 

will  maintain  the  health  in  years  to  come.  It  is  believed  that 
all  habits  of  play  in  the  open  air  tend  to  do  this. 

The  Work  Fallacy.— It  has  been  generally  held  in  the 
past  that  country  children  did  not  need  physical  training 
because  they  got  the  necessary  physical  development  from 
the  work  of  the  farm,  but  it  must  be  remembered  that  the 
work  of  the  farm  has  been  almost  completely  transformed  in 
the  last  half-century.  From  being  a  day  laborer  the  farmer 
has  become  a  mechanic  and  a  scientist.  He  has  no  more  forests 
to  clear.  He  is  ceasing  to  hold  the  handles  of  his  plough 
about  stumps  and  stones.  Ploughs,  cultivators,  rakes,  mowers, 
and  reapers  have  all  become  vehicles  to  carry  him  about  his 
farm.  Driving  a  team  is  usually  not  strenuous  exercise.  So 
far  as  the  boy  works  with  his  hands,  it  is  apt  to  be  hoeing 
in  the  garden  or  pulling  weeds.  Such  work  frequently  tends 
to  cramp  the  chest  and  to  bring  the  shoulders  forward.  While 
farm  implements  have  seats,  the  seats  usually  have  no  backs, 
and  the  farmer  is  apt  to  sit  collapsed.  There  is  very  little 
work  on  the  modern  farm,  with  all  its  machinery,  that  can 
develop  the  heart  and  lungs,  as  did  the  chopping  and  mowing 
and  cradling  and  pitching  of  hay  and  wheat  of  pioneer  days. 
Physical  strength  is  becoming  relatively  less  important  on  the 
farms  as  elsewhere,  while  vital  strength,  which  consists  es- 
sentially of  the  strength  of  the  heart,  lungs,  sex,  nerves,  and 
digestion,  is  no  less  important  now  than  formerly.  Country 
boys  and  girls  are  apt  to  be  round-shouldered  and  flat-chested, 
with  forward-slanting  heads.  Boys  who  have  done  much  hard 
work  are  usually  awkward  and  clumsy,  almost  without  that 
grace  and  suppleness  that  are  characteristic  of  a  child  who  has 
been  trained  through  play.  Country  children  generally  have 
more  stable  nerves  than  city  children.  Their  digestion  is 
commonly  good.  But  they  are  apt  to  be  deficient  in  lung 
capacity  and  heart  development. 

Play  at  the  Country  School. — So  far  as  the  rural  school 
promotes  physical  education,  it  is  almost  entirely  through 
play  and  athletics.     There  are  practically  no  gymnastics  in 


458  EDUCATIONAL  HYGIENE 

country  schools  in  America,  though  they  take  a  considerable 
time  in  the  scheme  of  the  rural  schools  of  Germany  and  Den- 
mark. Play  is  more  needed  at  the  rural  school  than  at  the 
city  school.  Throughout  the  country  the  farms  are  getting 
larger.  The  families  are  small  and  are  growing  smaller  from 
decade  to  decade.  It  is  becoming  increasingly  difhcult  for 
the  country  child  to  play  anywhere  except  at  school.  He 
can  practically  never  play  team  games  anywhere  else,  or 
other  games  that  take  a  considerable  number  of  players.  The 
farmer  is  apt  to  say  his  boy  does  not  need  to  play  baseball 
because  he  gets  plenty  of  exercise  at  home,  but  play  is  needed 
at  least  as  much  for  mental  health  as  for  physical  health  in 
the  country.  Play  must  give  grace  and  suppleness,  strength 
of  heart  and  lungs,  correct  physical  defects,  give  resistance 
against  disease,  establish  hygienic  habits,  and  create  the  joy 
of  life.  It  is  more  needed  at  the  country  school  than  else- 
where, because  it  is  almost  the  only  chance  the  country  boy 
has  to  play,  and  because  the  rural  school  must  introduce  the 
spirit  of  play  into  rural  life,  which  has  grown  so  serious  and 
hard  that  it  is  driving  the  boys  and  girls,  and  even  the  farmers 
themselves,  from  the  farms.  ^ 

Larger  Grounds  for  the  Rural  School. — If  the  rural  school 
is  to  deal  effectively  with  its  problem,  the  first  requirement 
is  a  larger  ground,  and  a  ground  that  is  suitable  for  play. 
Institute  work  and  lecturing  take  me  into  nearly  every  State 
in  the  Union  and  everywhere  I  find  nearly  the  same  con- 
ditions. Usually  the  yard  is  not  more  than  half  an  acre  in 
area.  It  is  often  evident  that  it  must  have  been  selected  for  a 
playground  because  it  was  good  for  nothing  else.  Very  seldom 
indeed  is  there  any  attempt  to  make  it  attractive  with  fences 
or  vines  or  trees.  In  less  than  one  per  cent  of  the  grounds  is 
there  any  play  equipment.  Great  interest  is  manifested  in 
educational  circles  just  now  in  the  improvement  of  the  rural 
school,  and  it  may  fairly  be  said  in  a  large  way  to  occupy  the 
centre  of  the  educational  stage.     While   the  percentage  of 

^  See  Curtis,  "Play  and  Recreation  for  the  Open  Country  "  (Ginn). 


PLAY   AND   RECREATION   AT   THE   RURAL   SCHOOL      459 

country  children  to  city  children  is  decreasing  from  year  to 
year  and  faster  than  the  percentage  of  rural  adults  to  city 
adults,  the  majority  of  the  children  are  still  educated  in  rural 
schools.  There  are  probably  at  present  only  about  one 
hundred  and  fifty  counties  in  this  countr}-  where  there  is  any 
systematic  attempt  to  organize  play  for  country  children.  An 
appreciation  of  the  need  is  becoming  general,  however,  and 
we  may  expect  great  improvement  in  the  near  future.  State 
departments  are  now  often  recommending  that  rural  schools 
get  two  or  three  acres  as  a  minimum  area  for  school 
sites,  and  in  some  States  they  are  practically  compelling 
playgrounds  of  such  size,  by  refusing  otherwise  to  approve 
of  the  plans.  The  State  of  North  Dakota  by  law  now  re- 
quires two  acres  as  the  minimum  for  rural  schools.  This 
demand  for  a  larger  ground  springs  from  a  desire  for  a  larger 
use,  so  there  is  every  reason  to  expect  that  there  will  be  more 
play  and  better  play  at  the  rural  school  in  the  future  than 
there  has  been  in  the  near  past,  at  least. 

The  Consolidated  Rural  School. — All  rural  educational 
progress  is  moving  in  the  direction  of  the  consolidated  school. 
With  the  depletion  of  rural  population  and  smaller  families 
many  of  the  once  populous  one-room  schools  now  have  only 
five  to  ten  pupils.  It  is  expensive  to  hire  a  teacher  for  these 
few.  Everywhere  agriculture  and  domestic  science  are  com- 
ing in,  and  it  is  almost  impossible  to  teach  these  at  the  one- 
room  school.  But  to  my  mind  the  most  weighty  reason  of 
all  for  consolidation  is  a  social  one.  Country  children  are 
diffident  and  backward  on  account  of  a  lack  of  acquaintance- 
ship. More  than  any  other  child  the  country  child  needs  to 
go  to  a  large  school.  The  school  offers  the  only  opportunity 
that  country  children  have  to  play  team  games,  and  ofttimes 
there  are  not  enough  children  at  the  one-room  school  to  play. 
The  boy  in  America  who  has  never  learned  to  play  baseball 
is  quite  as  much  handicapped  as  the  boy  who  has  never 
learned  arithmetic.  The  great  handicap  of  the  country  is  its 
isolation,  and  the  natural  cure  of  that  isolation  is  a  social 


460  EDUCATIONAL  HYGIENE 

centre  where  the  people  can  come  together.  Probably  the 
consolidated  school  is  the  best  social  centre  that  a  rural  com- 
munity can  have.  There  are  several  States  that  now  give 
special  State  aid  to  consolidated  schools,  and  the  movement 
is  well  advanced  in  many  States. 

At  the  consolidated  school  there  is  usually  a  good-sized 
playground.  The  average  area  is  probably  not  less  than 
four  acres,  as  the  grounds  are  often  ten  to  twenty  acres  in 
size.  In  some  cases  there  is  an  attempt  to  have  a  township 
picnic-grove  and  ball-field  at  these  grounds  also.  On  these 
grounds  there  is  opportunity  both  for  the  play  of  the  school- 
children and  of  the  young  men  of  the  community  as  well. 
The  consolidated  school  makes  possible  most  of  the  things 
that  are  essential  to  the  welfare  of  the  rural  community.^ 

Better  Games. — If  play  is  really  to  meet  the  need  of  phys- 
ical and  social  training  in  the  country,  there  must  be  better 
games.  We  usually  think  of  baseball  as  the  one  game  for 
boys,  but  baseball  is  not  adapted  to  the  one-room  schools  of 
the  country,  because  it  requires  more  ground  and  more  older 
boys  than  there  are  at  these  schools.  Probably  less  than  one 
per  cent  of  them  have  eighteen  boys  who  are  old  enough  to 
play  baseball.  Baseball  at  best  has  a  narrow  age  range, 
from  about  twelve  to  twenty-five.  It  does  not  meet  the  need 
of  the  girls  at  all,  and  the  girls  need  the  play  far  more  than 
the  boys  do  because  they  get  so  much  less  open  air  and  play 
than  the  boys  at  best.  Indoor  baseball,  with  its  smaller 
diamond,  fewer  players,  and  large  soft  ball,  is  a  much  better 
school  game  than  baseball,  because  it  does  not  require  so  much 
room  and  because  it  has  a  far  wider  age  range,  as  it  may  be 
played  by  any  one  from  eight  to  sixty.  It  has  a  far  wider 
time  range,  as  it  is  played  in  the  fall  as  well  as  the  spring, 
and  in  the  late  fall  and  early  spring  when  the  sting  of  a  hard 
baseball  would  be  insufferable.  It  is  played  by  the  girls 
nearly  as  much  as  the  boys,  and,  as  it  has  a  very  much  smaller 

'  See  Monahan's  bulletin  on  consolidation  by  the  U.  S.  Bureau  of  Edu- 
cation. 


PLAY   AND   RECREATION   AT   THE   RURAL   SCHOOL      46 1 

field,  it  can  be  played  very  comfortably  with  five  players  on 
a  side.  Indoor  baseball  is  played  mostly  out  of  doors  at 
present,  on  a  thirty-five-foot  diamond. 

Probably  the  best  game  there  is  for  the  rural  school  is 
volley-ball,  a  game  played  with  a  large  inflated  ball  over 
a  tennis-net  or  rope.  This  game  has  several  very  great 
advantages.  Most  country  children  are  stooped  and  round- 
shouldered;  volley-ball  requires  the  player  to  keep  his  head 
and  shoulders  back  and  is  a  natural  corrective  of  these 
bad  positions.  Volley-ball  is  played  by  the  girls  as  much  as 
the  boys,  and,  as  was  said  before,  the  girls  are  the  great 
problem.  Country  girls  seldom  learn  how  to  play  any  ath- 
letic games,  as  the  tradition  is  that  vigorous  play  is  unlady- 
like. Girls  at  fourteen  have  only  three-quarters  the  lung 
"capacity  of  boys  of  the  same  age.  Blood  tests  always  show 
their  blood  to  be  in  poorer  condition  on  the  average.  The 
German  figures,  given  by  Schmidt,  indicate  that  tuberculosis 
is  about  25  per  cent  more  prevalent  among  girls  than  boys 
in  Germany.  Volley-ball  can  be  played  fairly  well  with  two 
players  on  a  side  and  even  the  one-room  school  will  usually 
have  at  least  four  children  who  are  eight  years  old  or  older. 
Volley-ball  has  the  widest  age  range  of  any  of  our  games 
except  golf,  as  it  can  be  played  very  comfortably  until  the 
player  is  seventy.  It  thus  not  merely  meets  the  needs  of  the 
school  years  but  of  later  life  as  well. 

There  should  be  croquet  at  the  country  school,  because 
croquet  is  a  good  country  game  and  the  school  must  intro- 
duce it  into  the  community. 

Tennis  is  another  game  that  is  in  every  way  suited  to  the 
country  school  and  the  country  community,  and  it  should  be 
played  at  the  school,  if  there  are  older  scholars,  for  the  same 
reason  that  croquet  should  be,  in  order  to  introduce  into  coun- 
try life  and  custom  a  game  that  is  suited  to  the  children  and 
adults  alike.  Tennis  is  the  country  game  of  England.  It 
takes  too  much  land  for  the  city,  but  is  in  every  way  suited 
to  rural  conditions. 


462  EDUCATIONAL  HYGIENE 

If  the  school  is  very  small  indeed,  say  three  or  four  pupils, 
tether-ball  is  probably  the  best  game  of  all.  Of  course,  there 
are  many  games  of  lower  organization,  such  as  prisoner's  base 
and  pull-away,  that  the  children  should  also  play. 

In  introducing  games,  only  one  new  game  should  be  started 
at  a  time,  and  this  should  be  played  until  the  children  have 
become  skilful  and  begin  to  tire  of  it  before  another  game 
should  be  started.  There  should  always  be  an  attempt  to 
secure  permanent  teams  and  to  keep  the  score  from  day  to 
day.  Scrub  teams  never  get  anywhere.  They  do  not  secure 
practise  or  inspire  loyalty.  In  order  to  get  any  new  game 
started  it  is  almost  necessary  for  the  teacher  to  play  with  the 
children  continuously  until  some  little  skill  is  acquired.  There 
are  four  sizes  of  the  indoor  baseball.  If  the  ground  is  of  good 
size,  the  four  teen-inch  ball  is  usually  preferred  by  the  chil-- 
dren.  But  in  small  grounds,  especially  where  the  children 
wish  to  play  long  ball  also,  as  they  usually  do,  the  seventeen- 
inch  ball  is  best.  In  prairie  countries,  where  high  winds  are 
common,  the  seventeen-inch  baseball  is  more  serviceable  as  a 
volley-ball  than  the  regular  ball.  It  can  also  be  used  very 
satisfactorily  in  playing  dodge-ball  and  a  number  of  other 
games.  The  rules  for  volley-ball  and  indoor  baseball  can  be 
secured  of  any  athletic  supply  house.  For  general  games 
consult  "  Games  for  the  Playground,  Home,  School,  and  Gym- 
nasium," by  Jessie  Bancroft;  "Education  by  Plays  and 
Games,"  by  George  Johnson;  and  "The  Teaching  of  Play," 
by  W.  P.  Bowen. 

Play  Equipment. — School  people  are  apt  to  think  that  the 
introduction  of  play  into  the  school  means  the  erecting  of 
swings,  giant  strides,  see-saws,  etc.  In  matter  of  fact,  such 
equipment  is  of  minor  importance  and  may  be  omitted  al- 
together without  seriously  handicapping  the  work.  In  the 
organization  of  play,  the  first  thing  to  do  is  to  furnish  the 
equipment  for  the  games.  A  baseball  is  essentially  communal 
property.  All  the  members  of  the  two  teams  that  play  with 
it  use  it  alike.     A  boy  cannot  be  expected  to  furnish  base- 


Boys  on  giant  stride  and  girls  at  volley-ball,  at  Pasadena,  Cal. 


Physical  training  in  the  open  air,  Pasadena,  Cal. 
Get  the  children  out  of  doors  for  physical  training  whenever  possible 


PLAY   AND   RECREATION   AT   THE   RURAL    SCHOOL      463 

balls  to  the  school,  and  of  course  the  same  is  true  of  bats, 
volley-balls,  and  many  other  similar  pieces  of  apparatus. 
If  the  school  wishes  to  encourage  baseball  or  volley-ball,  it 
muse  furnish  the  balls  and  other  equipment.  This  is  by  far 
the  most  important  apparatus  for  any  playground.  Of  course, 
the  pupils  may  co-operate  to  purchase  such  equipment  or 
other  means  may  be  invented  for  raising  the  necessary  money. 

Second  in  importance  comes  the  equipment  for  such 
athletics  as  are  suited  to  the  rural  school.  There  should  be 
a  horizontal  bar  with  sand  underneath,  where  the  boys  can 
chin  and  do  stunts.  All  boys  like  to  perform  on  a  horizontal 
bar,  but  if  it  is  over  the  hard  ground  there  are  likely  to  be 
serious  accidents.  There  should  always  be  a  jumping-pit 
filled  with  sand  and  with  a  take-ofT  board  set  plumb  with  the 
ground.  Children  between  eight  and  twelve  are  probably 
more  fond  of  running  and  jumping  than  they  will  ever  be 
again.  It  is  well  to  have  the  distances  marked  in  feet  and 
half  feet  on  the  side  of  the  pit.  There  should  be  the  standi 
ards  for  the  high  jump  as  well,  as  the  children  are  rather  more 
fond  of  the  high  jump  than  they  are  of  the  broad  jump.  Some- 
where at  the  side  of  the  ground  or  along  the  road,  if  it  is 
level  and  in  good  condition,  a  sixty  and  one-hundred  yard  dash 
should  be  marked  off.  Children  all  delight  in  these  contests. 
A  stop-watch  adds  very  greatly  to  the  interest  in  running,  but 
children  love  to  run  against  each  other  even  if  they  do  not 
know  their  time.  A  race  that  is  more  than  a  hundred  yards  is 
seldom  wise  at  the  district  school. 

For  various  reasons,  the  swings  and  see-saws  cannot  make 
the  same  bid  for  school  support  that  the  equipment  that  I 
have  mentioned  can.  A  baseball  is  meaningless  as  individ- 
ual property.  A  boy  cannot  play  baseball  alone.  A  swing  is 
usually  individual  property,  as  only  one  or  two  children  can 
swing  at  a  time.  The  swing  causes  many  quarrels  and  acci- 
dents. It  is  relatively  expensive,  and  hard  to  take  care  of. 
It  gives  no  social  training  and  little  physical  training.  The 
country  child  is  with  companions  all  too  little.     While  he 


464  EDUCATIONAL  HYGIENE 

is  with  them  he  should  play  social  games  that  he  cannot  play 
at  home.  The  swing  and  the  see-saw  belong  properly  at  home 
and  not  at  school.  The  only  reason  why  it  would  be  worth 
while  to  install  them  at  the  school  at  all  is  in  order  that  the 
parents  may  be  encouraged  to  put  them  into  the  dooryard. 
It  is  probably  well  to  have  a  sand-bin  for  the  Uttle  children, 
though  this  also  belongs  rather  to  the  home  than  the  school. 

If  the  school  directors  are  not  willing  to  furnish  the  equip- 
ment that  is  needed,  the  school  itself  can  usually  do  it  by  hold- 
ing an  entertainment.  This  entertainment  will  probably  be 
also  a  valuable  social  occasion  to  the  country,  will  make  the 
teacher  acquainted  with  the  parents,  and  will  be  a  real  edu- 
cation for  the  children  in  social  service.  Forty-seven  such 
entertainments  were  held  in  Winnebago  County,  Illinois,  last 
year,  which  yielded  on  an  average  a  little  more  than  thirty- 
five  dollars  apiece.  This  is  ample  for  the  play  needs  of  a 
rural  school  for  a  year  or  more. 

The  Standard  Athletic  Test. — The  standard  athletic  test 
was  designed  by  Doctor  Gulick  while  he  was  director  of  phys- 
ical training  in  New  York  City.  It  is  practically  a  pass  mark 
in  physical  training.  By  the  time  a  boy  is  thirteen  years  of 
age  we  expect  him  to  be  in  the  seventh  grade.  The  test  says 
that  by  this  time  he  should  be  able  to  chin  a  bar  four  times, 
jump  five  feet  nine  inches  standing,  and  run  a  sixty-yard  dash 
in  eight  and  three-fifths  seconds.  We  all  tend  to  come  up  to 
standards  if  we  only  know  what  they  are  and  what  is  ex- 
pected of  us.  The  test  should  be  carried  on  to  the  adults. 
This  test  was  tried  out  in  Ulster  County,  N.  Y.,  upon  the 
country  children.  The  farmers  thought  in  the  beginning 
that  anything  that  city  boys  could  do  would  be  '"pie"  for 
sturdy  country  boys,  but  were  surprised  to  find  that  scarcely 
a  boy  could  pass  the  test.  This  set  the  boys  to  practising  all 
over  the  county,  with  the  result  that  many  were  able  to  pass 
before  the  year  was  over.  In  some  places  it  is  customary  to 
let  the  boys  try  out  in  one  event  at  a  time,  taking  possibly 
first  the  chinning,  then  the  jumping,  and  finally  the  running. 


PLAY  AND   RECREATION   AT   THE   RURAL   SCHOOL      465 

In  other  places  they  require  them  to  practise  all  the  events 
together  and  do  the  three  stunts  at  one  test. 

The  new  standards  and  rules  may  be  had  from  the  hand- 
book of  the  Public  School  x^thletic  League  issued  by  Spalding, 
or  from  the  Playground  and  Recreation  Association  of  America 
at  No.  I  Madison  Avenue,  New  York.  The  new  test  is  a 
graded  test  as  follows: 

First  Test 

Pull-up  (chinning) 4  times. 

Standing  broad  jump 5  feet  q  inches. 

60-yards  dash 8%  seconds. 

Second  Test 

Pull-up  (chinning) 6  times. 

Standing  broad  jump 6  feet  6  inches. 

60-yards  dash 8  seconds. 

Or  loo-yards  dash 14  seconds. 

Third  Test 

Pull-up  (chinning) g  times. 

Running  high  jump 4  feet  4  inches. 

220-yards  run , 28  seconds. 

The  following  general  rules  shall  govern  the  final  com- 
petition: 

No  boy  is  permitted  to  receive  more  than  one  badge  for  any  grade 
in  any  one  year. 

It  is  necessary  to  qualify  in  all  three  events  in  any  one  class  in 
order  to  win  a  badge. 

There  shall  be  but  one  trial  in  chinning,  one  in  the  dashes,  and  three 
in  the  jumps. 

Beautiful  bronze  badges  have  been  designed  by  Professor 
R.  Tait  McKenzie,  of  the  University  of  Pennsylvania,  for 
the  winners  of  these  three  tests.  These  are  furnished  by  the 
Playground  and  Recreation  Association  for  fifteen  cents  each. 

Interschool  Contests. — The  best  place  there  is  for  inter- 
school  contests  is  at  the  rural  school.     In  our  great  city  high 


466  EDUCATIONAL  HYGIENE 

schools  we  have  the  spectacle  of  eleven  sturdy  young  giants 
on  the  gridiron  getting  much  more  exercise  than  they  need, 
while  all  the  weaker  ones,  to  whom  football  might  have  been 
a  life-saver,  sit  on  the  grandstand  and  shout.  If  the  rural 
school  is  to  hold  contests  with  other  schools,  it  must  use  all 
its  available  material  on  its  ball  teams,  and  it  must  train  its 
weaker  members  in  order  to  win.  In  the  various  contests 
that  may  well  be  held  at  the  same  time,  nearly  ev^ry  child 
should  compete  in  something.  These  contests  are  a  great 
aid  in  developing  enthusiasm  and  getting  the  children  to 
practise.  They  are  essential  to  the  larger  education  of  the 
country  child,  because  the  country  children  have  no  sports- 
manship. They  do  not  know  what  it  is.  They  cheer  their 
opponents'  mistakes,  try  to  annoy  them  in  their  play,  call 
them  names,  dispute  decisions,  and  the  like.  They  do  these 
things  because  they  do  not  understand  that  these  things  are 
unsportsmanlike.  Sportsmanship  is  essentially  primitive  eth- 
ics of  the  sort  to  which  the  boy  is  most  subject  and  he  can- 
not afford  to  miss  the  training. 

Country  children  are  diffident  and  backward  on  account 
of  the  lack  of  experience  and  acquaintanceship.  Almost  any- 
thing that  takes  them  out  of  their  own  neighborhood  to  meet 
other  children  and  compete  with  them  will  be  valuable. 

The  rural  school  has  no  loyalty.  The  easiest  way  to  de- 
velop it  is  always  through  contests  with  another  school. 

Play  Festivals.— A  considerable  number  of  counties  in  sev- 
eral States  are  now  holding  play  festivals  every  year.  This 
is  apt  to  be  a  large  event  and  arouse  much  enthusiasm.  It  is 
one  of  the  most  hopeful  means  of  setting  the  whole  country- 
side to  playing.  The  long  races  are  to  be  avoided,  and  if 
basket-ball  is  played  it  should  be  for  short  halves.  The  first 
rural  play  festival  in  this  country,  so  far  as  I  know,  was  organ- 
ized by  President  Scudder,  of  the  New  Paltz  Normal  School, 
in  1905.  There  are  a  number  of  normal  schools  that  are  now 
holding  each  year  similar  play  festivals  for  the  children  of  the 
counties  in  which  they  are  placed.    There  are  now  some  ninety 


PLAY  AND   RECREATION  AT  THE   RURAL   SCHOOL      467 

or  more  county  secretaries  of  the  Young  Men's  Christian  As- 
sociation, nearly  all  of  whom  are  organizing  athletics  over  at 
least  a  part  of  the  county  in  which  they  are  placed.  There 
are  probably  a  hundred  or  more  county  superintendents  of 
schools  that  are  organizing  athletics  and  play  festivals  in  their 
counties.  There  are  no  statistics,  but  in  most  large  gather- 
ings of  teachers  in  whatever  State  they  are  held  I  meet  one 
or  more  such  superintendents.  Probably  the  most  salutary 
thing  that  could  happen  to  the  rural  community  would  be 
to  give  the  county  superintendent  an  assistant  who  might 
organize  the  recreational  facilities  of  the  school  and  the  com- 
munity; or,  in  the  face  of  the  present  social  unrest  in  the 
country,  perhaps  it  would  be  better  to  give  the  supervisor  of 
recreation  an  assistant  who  should  be  superintendent  of 
schools.  The  State  and  local  supervisors  of  hygiene  as  sug- 
gested in  former  chapters  will  meet  the  need  in  an  ideal  way. 

Perhaps  the  largest  and  most  successful  rural-play  festival 
that  is  being  held  is  the  one  that  is  organized  by  a  special 
committee  at  Amenia,  N.  Y. 

The  School  Excursion. — ^The  school  excursion  is  little 
known  here,  but  it  is  very  common  abroad.  In  Germany 
these  trips  not  infrequently  cover  a  hundred  miles  or  more, 
and  last  for  a  week  or  even  three  or  four  weeks,  during  the 
summer  at  times.  The  children  walk  from  place  to  place 
and  cook  their  meals  by  the  wayside.  They  sleep  in  the  barns, 
on  the  floors  of  inns,  in  the  barracks  of  the  soldiers,  or  in 
special  schoolrooms  transformed  into  dormitories  for  the 
purpose  during  the  summer.  They  have  a  good  time,  hold 
athletic  contests  with  children  in  other  villages,  and  come  to 
know  the  country  and  the  people  at  first  hand.  They  become 
so  fond  of  these  walking  trips  that  they  continue  to  walk  for 
the  rest  of  their  Hves. 

It  is  essential  that  we  should  introduce  these  excursions 
into  our  schools,  for  various  reasons.  Walking  is  good  exercise, 
and,  if  an  enthusiasm  for  it  is  once  acquired,  it  is  likely  to  be 
continued  during  the  remainder  of  the  life.     One  of  the  serious 


468  EDUCATIONAL  HYGIENE 

deficiencies  of  country  life  is  that  country  people  have  never 
learned  to  love  the  country  or  to  observe  the  nature  world 
around  them.  As  the  German  children  are  on  the  way  the 
teacher  points  out  to  them  the  distant  landscape,  the  beauti- 
ful sunset,  or  mountain  view.  They  come  to  know  and  love 
the  common  birds  and  flowers.  I  am  persuaded  from  my  own 
experience  that  children  will  learn  far  more  that  they  will 
remember  on  such  trips  than  they  will  in  any  similar  amount 
of  time  in  school.  Isolation  is  usually  held  to  be  the  greatest 
drawback  of  the  country,  and  walking,  especially  for  girls 
and  women,  who  often  do  not  have  a  horse  at  command,  is 
the  most  fundamental  of  all  ways  of  overcoming  isolation. 

I  should  like  to  see  Friday  afternoons  during  the  pleasant 
weather  of  the  year  devoted  to  these  trips,  and  occasionally 
there  should  be  a  week-end  camp  of  the  girls  with  their  woman 
teacher,  or  of  the  boys  with  their  man  teacher.  There  is  no 
other  similar  opportunity  to  get  a  personal  hold  over  children. 

The  Boy  Scouts. — The  Boy  Scouts  is  a  very  recent  order. 
Begun  not  more  than  ten  years  ago,  it  has  already  encircled 
the  world  and  is  found  in  every  civilized  country.  The  Boy 
Scouts  of  America  was  organized  in  January,  1910.  But 
there  are  now  more  than  three  hundred  thousand  Scouts  under 
some  seven  thousand  Scout  Masters  in  this  country.  The 
order  is  seeking  to  train  into  boys  the  hardihood  and  re- 
sourcefulness of  the  pioneer,  to  give  a  love  of  nature,  and  the 
arts  of  the  woods  and  fields.  It  encourages  walking  and 
camping,  athletics,  chivalry,  and  courage. 

Scouting  appeals  to  the  love  of  adventure  and  activity, 
which  are  fundamental  to  boy  nature.  The  Scouts  are  offer- 
ing to  boys  what  they  have  always  loved  to  read  about  and 
longed  to  do.  The  Scouts  are  now  organized  in  nearly  every 
small  village  in  the  United  States,  but  the  order  has  scarcely 
touched  the  country.  Under  existing  circumstances  the  rural 
village  is  undoubtedly  the  best  place  for  the  organization  of 
the  order.  It  is  not  far  from  the  village  into  the  open  country 
for  walks  and  scouting.    There  is  apt  to  be  in  the  village  some 


PLAY   AND   RECREATION  AT  THE   RURAL   SCHOOL      469 

one  who  may  be  Scout  Master.  The  boys  have  plenty  of 
time  and  they  need  the  training.  The  boys  on  the  farm  do 
not  need  the  order  so  much.  They  are  in  contact  with  nature 
already.  They  are  getting  some  of  the  Scout  experiences 
directly,  and  are  learning  to  do  some  helpful  kinds  of  work. 
But  the  great  diflEiculty  in  the  way  of  the  organization  of  the 
Scouts  in  the  country  is  the  impossibility  of  securing  Scout 
Masters.  Scout  Masters  are  not  paid,  and  the  country  has 
not  yet  developed  the  spirit  of  social  service.  There  are  very 
few  farmers  who  would  feel  like  undertaking  it  even  if  they 
were  paid.  The  only  possibility  of  a  general  organization  of 
the  Scouts  in  the  country  seems  to  be  to  put  them  into  the 
curriculum  of  the  consolidated  school.  There  they  would  be 
possible,  and  I  believe  well  worth  while. 

The  Camp  Fire  Girls. — The  Camp  Fire  Girls  is  an  order 
similar  in  every  way  to  the  Boy  Scouts  and  of  still  more 
recent  origin.  It  is  also  offering  to  girls  just  what  they  have 
always  wanted  to  do,  and  it  also  requires  the  presence  of  an 
adult,  the  Guardian  of  the  Camp  Fire.  Every  encouragement 
is  given  to  the  girls  to  go  on  walks,  to  camp  out,  to  learn  folk- 
dances,  to  swim,  etc.  It  appeals  to  the  romance  in  girl  nature 
much  as  scouting  appeals  to  the  love  of  adventure  in  the 
boy  nature.  The  Camp  Fire  Girls  have  had  a  marvellous 
development  all  over  the  country,  as  they  have  deserved 
to  have.  The  training  which  they  are  giving  for  the  life  of 
woman  is  far  more  fundamental  than  that  of  the  school. 
The  same  limitations  apply  to  the  Girls  as  to  the  Boy  Scouts. 
It  is  almost  or  quite  impossible  at  present  to  find  "  Guardians 
of  the  Camp  Fire"  in  most  country  sections.  Hence  the  order 
is  little  organized  there.  The  rural  village  is  the  best  place 
for  them,  as  all  the  conditions  are  there  favorable.  I  believe 
that  the  Camp  Fire  Girls  also  richly  deserve  a  portion  of  the 
school  time.  The  Camp  Fire  Girls  receive  honors  for  swim- 
ming and  athletics.  They  take  long  walks  and  camp  out. 
They  must  sleep  with  their  windows  open,  and  learn  to  live 
the  open-air  life. 


470  EDUCATIONAL  HYGIENE 

Saturday  Half-Holiday  in  the  Country. — During  a  large 
part  of  the  year  the  one  well-nigh  impassable  barrier  to  all 
social  and  recreational  developments  in  the  country  is  the 
lack  of  time.  Farm  people  cannot  work  twelve  and  fourteen 
hours  a  day  for  six  days  a  week  and  have  left  either  the  time 
or  the  energy  with  which  to  play.  Since  they  are  isolated  in 
their  work,  it  is  far  more  important  that  farm  people  should 
have  some  time  and  place  where  they  can  get  together  than 
it  is  for  city  people  to  have  a  half-holiday  or  a  social  centre. 
Without  the  Saturday  half-hoHday  it  is  going  to  be  nearly  or 
quite  impossible  to  hold  the  boys  and  girls  and  the  hired  men 
on  the  farms.  The  half-holiday  is  essential  to  the  welfare  of 
the  country  both  socially  and  intellectually.  The  work  of 
the  farm  is  mostly  solitary.  It  furnishes  abundant  opportu- 
nities to  think.  Farmers  as  a  class  are  apt  to  be  dignified  and 
substantial  people,  whose  independence  and  self-respect  have 
been  among  the  chief  assets  of  the  republic.  These  qualities 
have  been  developed  in  the  silent  and  thoughtful  work  of  the 
fields.  Such  work  has  often  been  highly  educational,  but 
that  can  only  be  when  the  mind  takes  up  from  time  to  time 
new  thoughts  to  be  worked  over  in  the  fields,  as  the  cow  chews 
her  cud  in  the  evening.  If  the  mind  does  not  have  new  ex- 
periences to  elaborate,  this  time  in  the  fields  is  apt  to  be 
largely  lost  to  culture. 

Liberty  H.  Bailey  says:  ''The  Saturday  half-holiday  is  com- 
ing in  the  country  and  coming  fast."  I  have  found  it  fairly 
common  in  parts  of  the  Northwest,  but  there  are  many  sec- 
tions of  the  country  where  it  is  still  almost  unknown.  If  there 
may  be  tennis-grounds  and  ball-fields  and  a  picnic-grove  at 
the  consolidated  or  township  school,  and  the  community  may 
meet  there  on  Saturday  afternoons  during  six  months  of  the 
year,  it  will  do  more  to  solve  the  problem  of  rural  life  than 
anything  else  that  I  know.  Here  the  boys  might  play  baseball 
or  practise  scouting.  The  girls  might  play  volley-ball  or  cro- 
quet or  tennis,  or  have  their  Camp  Fire.  The  little  children 
could  play  their  games,  and  the  parents  could  have  tlieir  picnic 


Tomatoes — Summer-school  garden,  Alontclair,  N.  J. 


Courtesy  of  Superintendent  D.  C.  Bliss,  Montclair,  N.  J. 

School  gardens.     These  are  of  vakie  in  country  and  city  for  hygienic 
development 


PLAY  AND   RECREATION  AT  THE   RURA"    «^CHOOL      47 1 

and  social  time.  The  teacher  of  agriculture  might  well  give 
a  lesson  or  demonstration  to  the  adults  at  this  time,  or  the 
farmers  might  drive  to  a  neighboring  farm  where  some  in- 
teresting crop  was  being  raised.  I  find  that  they  are  using 
the  tree  claims  for  these  Saturday-afternoon  picnics  in  parts 
of  North  Dakota. 

The  Social  Centre. — A  rapid  development  of  rural  soc'al 
centres  is  now  going  on  in  Minnesota  and  Wisconsin.  In 
other  sections  the  movement  is  less  prominent,  but  there  are 
beginnings  throughout  the  country.  Undoubtedly  the  social 
centre  is  more  needed  in  the  country  than  it  is  in  the  city, 
because  it  is  the  country  that  most  of  all  lacks  social  op- 
portunity. The  social  centre,  however,  belongs  more  to  the 
social  and  educational  side  of  life  than  the  physical  in  the 
country.  It  has  far  more  to  do  with  mental  hygiene  than  it 
has  to  do  with  physical  hygiene  or  physical  training.  How- 
ever, many  of  the  new  township  high  schools  and  agricultural 
schools  and  consolidated  schools  have  gymnasiums,  and  these 
are  being  used  more  or  less  in  the  evenings  for  basket-ball, 
volley-ball,  and  folk-dancing.  There  is  an  abundance  of 
time  for  the  older  boys  and  girls  to  take  part  in  these  activ- 
ities during  the  long  winter  evenings  in  the  country,  and  it  is 
to  be  hoped  that  a  gymnasium  will  be  a  part  of  the  equip- 
ment of  all  new  consolidated  schools  as  it  already  is  of  very 
many,  and  that  it  may  be  fully  used  by  night  as  well  as  by 
day.  If  the  principal  of  this  consolidated  school  may  now 
receive  a  small  extra  compensation  as  the  director  of  the 
social  centre  and  as  Scout  Master  for  the  boys,  almost  any- 
thing is  possible  in  the  country  community. 


IV.    THE  TEACHING  OF  HYGIENE 

CHAPTER  XXV 

THE   TEACHING   OF   HYGIENE   IN   ELEMENTARY 
SCHOOLS 

I.  The  Importance  of  Hygiene  in  the  Elementary  School 
Curriculum. — The  watchword  of  the  present  day  is  effi- 
ciency. The  idea  that  our  future  welfare  and  prosperity  de- 
pend on  the  conservation  of  our  resources  is  fast  gaining 
ground  in  America.  The  modern  scientific  conception  of 
efficiency,  which  was  born  amid  the  needs  of  industry,  is  now 
being  successfully  applied  to  almost  every  field  of  human 
endeavor.  Quite  recently,  however,  we  have  begun  to  realize, 
as  never  before,  that  efficiency  must  begin  with  the  health  of 
the  individual  and  not  with  knowledge  and  action.  Ill  health 
is  now  being  looked  upon  as  a  great  economic  waste,  and  means 
are  being  taken  to  prevent  it.  Numerous  insurance  companies, 
for  example,  have  appointed  physicians  and  nurses  whose 
business  it  is  to  keep  the  policy-holders  well.  Many  indus- 
trial concerns,  moved  more  by  the  idea  of  efficiency  and 
economy  rather  than  by  a  feeling  of  sympathy,  have  found 
it  worth  while  to  provide  free  medical  attendance  as  well 
as  high-class  sanitary  measures  for  their  employees.  As 
psychology  and  hygiene  become  more  and  more  scientific  it 
becomes  clear  that  knowledge,  skill,  morality,  the  satisfying 
of  all  the  worthy  satisfactions  of  life,  depend  largely  on  health. 
In  the  light  of  such  a  growing  conviction  it  is  obvious  that 
the  three  R's  must  recede  to  the  background  in  their  order  of 

472 


HYGIENE   IX   ELEMENTARY    SCHOOLS  473 

importance.  It  is  immeasurably  more  valuable  to  be  healthy 
than  to  know  how  to  diagram  English  sentences,  bound 
Africa,  or  write  a  promissory  note.  The  healthy  boy  or  girl 
working  under  hygienic  conditions  is  able  also  to  do  more- 
school  work  and  do  it  better.  Hygiene  must  then  be  regarded 
as  the  most  important  subject  of  the  curriculum.  President 
G.  Stanley  Hall  has  well  said:  "What  doth  it  profit  a  child  if 
he  gain  the  whole  world  of  knowledge  and  lose  his  own 
health?"  We  might  well  ask  now:  "What  is  the  present 
status  of  this  important  subject  in  the  elementary  schools?" 

II.  The  Failure  of  Health  Instruction  in  the  Grades. — 
That  the  health  instruction  in  the  public  schools  has  im- 
proved within  the  last  few  years  is  not  to  be  doubted;  but  its 
effectiveness  is  still  to  be  questioned.  Doctor  McMurry,  a 
member  of  the  Hanus  Commission  which  investigated  the 
schools  of  New  York  City,  found  that  the  health  instruction 
was  wooden  and  far  from  practical.  Rapeer,  who  made  a 
careful  investigation  of  the  educational  hygiene  in  twenty- 
five  leading  cities,  says  of  the  teaching  of  hygiene:  "And  yet 
the  subject  is  a  tail-end  subject,  little  emphasized,  and  fur- 
nished with  poor  text-books  for  the  most  part,  and  very  fre- 
quently with  poor  teachers  in  the  gra,d6s  and  high  school. 
Colleges  do  not  usually  give  credit  for^nor  demand  a  knowledge 
of  this  vitally  essential  subject  of  health  and  how  to  get  and 
maintain  it,  much  to  their  disparagement,  and  consequently 
we  find  many  schools  almost  entirely  neglecting  it."  These 
two  investigations  reveal  conditions  that  most  educators 
would  probably  agree  are  typical  of  the  whole  country. 

The  writer  wishes  to  propose  the  following  reasons  for  the 
failure  in  the  teaching  of  hygiene  in  the  grades  below  the  high 
school: ' 

(i)  The  teachers  as  a  class  are  not  well  prepared  to  teach 
hygiene.  The  training  received  in  the  normal  schools  has  too 
often  emphasized  anatomy  .and  physiology  rather  than  hy- 
giene, and  little  or  no  time  has  been  devoted  to  it  in  the 
regular  normal-school  course.     As  a  result  the  teachers  are 


474  EDUCATIONAL   HYGIENE 

delicient  in  the  right  kind  of  knowledge.  They  have  not  yet 
learned  to  appreciate  either  the  importance  or  the  character 
of  efficient  health  instruction. 

(2)  The  psychology  and  pedagogy  of  hygiene  have  not 
as  yet  been  worked  out,  because  hygiene  is  really  one  of  the 
newest  subjects  in  the  curriculum.  The  disadvantage  con- 
nected with  the  teaching  of  hygiene  rather  than  arithmetic  is 
obvious  when  one  considers  the  splendid  devices  involving 
play  and  construction  and  the  standardized  subject-matter 
now  in  use  in  the  teaching  of  arithmetic  and  the  dearth  of 
these  devices  and  standards  in  the  teaching  of  hygiene. 

(3)  Many  of  the  text-books  still  in  use  devote  altogether 
too  large  a  proportion  of  space  to  anatomy  and  physiology. 
Much  of  the  material  in  these  books  is  too  difficult  for  chil- 
dren, and  in  some  cases  the  way  in  which  it  is  presented  leads 
to  prejudice  against  any  further  study  of  the  subject.  The 
writer  has  known  of  cases  where  the  children  referred  to 
lessons  in  hygiene  as  "nasty."  Such  an  attitude  can  scarcely 
be  expected  to  inspire  a  love  of  health  or  result  in  hygienic 
practises.  Fortunately,  however,  there  are  a  number  of  good 
books  on  hygiene  that  have  recently  appeared  that  could  be 
put  into  the  hands  of  children  with  profit. 

(4)  The  hygiene  that  has  been  taught  has  been  too  gen- 
eral and  abstract  and  has  aimed  at  knowledge  rather  than 
health  ideals  and  practise.  For  example,  teachers  often 
spend  much  time  on  the  anatomy  and  physiology  of  the  di- 
gestive system  to  the  neglect  of  such  vital  topics  as  food 
values,  the  hygiene  of  eating,  how  to  preserve  food,  how  to 
keep  it  from  becoming  contaminated,  the  right  kind  of  break- 
fasts for  children,  a  good  kind  of  lunch  to  bring  to  school,  etc. 

(5)  The  instruction  in  hygiene  is  not  well  organized  or 
standardized  through  the  grades,  hence  repetition  and  tedium 
both  for  teachers  and  for  pupils  are  common.  There  is  also 
a  common  neglect  of  essentials. 

(6)  The  aims  in  teaching  hygiene  have  not  been  clearly 
formulated.     Few  principals  of  the  elementary  schools  have 


HYGIENE   IN  ELEMENTARY   SCHOOLS  475 

clearly  in  mind  what  results  they  ought  to  get  by  the  time 
the  children  get  through  the  eighth  or  ninth  grade,  conse- 
quently there  has  been  little  systematic  planning  for  results. 

(7)  The  teachers  frequently  do  not  like  to  teach  hygiene. 
It  is  only  natural  to  expect  that  such  vagueness  as  to  aims, 
values,  and  methods  tends  naturally  to  dull  the  teacher's  zeal, 
spontaneity,  and  efficiency.  She  realizes  her  failures  in  teach- 
ing hygiene,  has  a  hearty  dislike  for  it,  and  slights  the  subject 
whenever  possible.  In  short,  the  psychology  and  pedagogy 
of  hygiene  are  still  crude  and  unsystematic. 

This  chapter  is  written  with  the  idea  of  helping  hygiene 
to  find  itself  by  suggesting  some  principles  for  guidance. 
The  brevity  and  scope  of  the  chapter  make  some  of  these 
assertions  sound  dogmatic.  At  best  they  can  be  regarded 
only  as  tentative.  The  old-fashioned  instruction  has  been  a 
failure.  We  must  have  a  programme  for  further  experi- 
mentation and  advance. 

III.  Fundamental  Facts  and  Principles  Involved  in  the 
Teaching  of  Hygiene. — It  is  the  belief  of  the  writer  that 
methods  of  teaching  hygiene  should  take  into  consideration 
the  following  facts  and  principles: 

(i)  The_  fundamental  aim  in  teaching  hygiene  should  he  the 
inculcating  of  the  ideals  and  habits  necessary  for  health  rather 
than  mere  knowledge.  It  is  better  to  have  the  habit  of  clean- 
ing one's  teeth  than  to  have  all  the  information  on  the  teeth 
that  is  available.  To  make  the  instruction  in  hygiene  really 
effective  the  teacher  should  have  a  good  knowledge  of  the 
psychology  of  habit  formation,  and  how  to  apply  it.  When- 
ever possible,  the  instruction  should  be  correlated  with  action. 
If,  for  example,  the  teacher  wishes  the  children  to  clean  their 
shoes  before  entering  the  schoolroom,  she  should  see  that  a 
place  is  provided  for  that  purpose,  and  she  must  then  insist 
that  the  shoes  be  cleaned  until  the  habit  has  been  gained. 
If  she  wishes  the  children  to  hang  their  wraps  on  individual 
hooks,  she  must  first  see  that  there  is  a  hook  for  each  in- 
dividual child  and  that  he  knows  where  it  is.     She  must  then 


476  EDUCATIONAL   HYGIENE 

see  that  he  hangs  up  his  wraps  regularly  until  the  process  has 
become  "second  nature"  to  him.  While  it  is  true  that  prac- 
tise is  more  important  than  knowledge,  yet  the  function  of 
proper  knowledge  in  promoting  action  should  never  be  over- 
looked. Whatever  may  be  said  in  disparagement  of  knowl- 
edge, it  is  nevertheless  plain  that  it  helps  rather  than  retards 
the  right  kind  of  practise. 

(2)  The  child  has  little  or  no  appreciation  for  health  as  a 
motive  for  future  action.  In  the  stirring  dramatic  world  in 
which  he  lives  there  is  almost  no  inclination  to  consider  the 
remote  consequences  of  his  behavior  on  health.  To  say  to 
the  small  boy,  "Now,  Johnny,  if  you  do  not  get  plenty  of 
fresh  air  you  will  not  be  strong,"  has  little  or  no  effect  on 
Johnny.  He  is  concerned  with  his  immediate  world  and  not 
with  the  problems  that  he  is  likely  to  have  six  months  or  ten 
years  hence.  Minor  illnesses,  which  might  be  expected  to 
serve  as  motives  for  action,  are  soon  forgotten,  and  it  is 
doubtful  whether  the  more  serious  ones  offer  anything  more 
than  specific  motives.  The  boy  who  is  dangerously  ill  because 
of  the  eating  of  green  apples  may  be  forever  cured  of  such 
action,  but  such  an  experience  would  not  deter  him,  probably, 
from  overeating  generally.  The  child  who  catches  cold  as  a 
result  of  neglecting  to  remove  his  wet  clothing  may  of  his 
own  accord  promptly  change  his  wet  clothing  in  a  similar 
situation,  but  such  an  experience  would  not  insure  his  taking 
plenty  of  exercise  in  the  open  air. 

(3)  Health  being  inadequate  as  a  motive,  one  of  the 
teacher's  great  problems  is  to  discover  motives  that  will  be 
effective.  What  is  going  to  happen  in  some  far-distant  time 
does  not  interest  the  child  in  the  least.  The  younger  the  child, 
the  truer  this  is.  All  the  instruction  must  centre  around  the 
child's  needs  and  interests.  The  child  is  interested  in  the 
approval  of  the  teacher,  in  activity,  play,  competition,  and 
imitation.^  To  such  instinctive  sources  the  teacher  must 
turn  for  the  forces  which  will  assimilate  her  instruction  and 

'  See  Thorndike's  "  Original  Nature  of  Man." 


HYGIENE   IN   ELEMENTARY   SCHOOLS  477 

make  for  action.  To  illustrate,  a  child  may  have  no  desire 
to  keep  his  desk  neat  and  clean,  but  if  there  is  competition 
among  the  pupils  of  a  school  he  is  likely  to  develop  a  new 
interest  in  the  appearance  of  his  desk.  Little  children  are 
naturally  interested  in  playing  at  keeping  house,  having 
te'^as,  etc.  Teachers  in  the  kindergartens  and  lower  grades 
may  easily  divert  these  impulses  into  habits  of  school  house- 
keeping and  personal  hygiene,  such  as  dusting,  setting  the 
table,  preparing  lunches,  use  of  napkin,  proper  chewing  of 
the  food,  cleaning  the  teeth,  and  keeping  the  room  free  from 
flies. 

(4)  Activity,  mental  and  physical,  is  one  of  the  essentials 
for  health.  The  first  law  of  the  child's  nature  is  action.  Every 
stimulus  around  him  moves  him  to  act.  There  is  little  use 
in  telling  children  about  the  great  need  of  exercise.  The 
problem  is  to  give  the  children  plenty  of  opportunity  to 
exercise  so  that  this  tendency  may  not  atrophy.  It  needs  also 
to  be  directed  along  the  right  channels.  If  the  teacher  gives 
the  child  opportunity  and  stimulus  to  express  his  playful  ac- 
tivities in  the  schoolroom  and  the  playground,  she  will  have 
accomplished  more  than  would  have  been  possible  through 
any  amount  of  formal  instruction.  A  permanent  interest  in 
physical  activity  should  be  one  of  the  goals  of  health  instruc- 
tion. It  is  doubtful  whether  the  work  in  physical  culture  in 
the  elementary  school  has  contributed  much,  if  anything,  to 
such  an  interest. 

(5)  The  structure  of  the  body — something  which  the 
child  cannot  see  and  a  knowledge  of  which  is  not  necessary 
for  the  solution  of  his  immediate  problems — is  not  very  in- 
teresting. Before  the  child  leaves  the  grades  he  ought,  of 
course,  to  have  some  kind  of  common  sense  and  scientific 
knowledge  of  how  his  body  is  made  and  how  it  works,  but  such 
knowledge  should  generally  be  free  of  technical  terms,  and 
should  in  every  case  be  presented  to  satisfy  his  curiosity  or 
to  support  his  knowledge  and  practise  of  hygiene.  The 
Gulick  "Hygiene  Series"  (Ginn  &  Co.),  for  example,  presents 


478  EDUCATIONAL  HYGIENE 

in  an  interesting  manner  all  the  anatomy,  physiology,  and 
hygiene  that  the  child  needs  to  know.^ 

(6)  There  is  grave  danger  in  isolating  the  instruction  in 
hygiene  so  that  the  child  is  led  to  think  of  hygiene  as  coming 
at  a  certain  time  of  the  day  but  having  no  further  relation 
to  his  Ufe  activities.  The  teacher  should  seize  opportunities 
in  other  lessons  to  give  information  in  hygiene,  and  whenever 
there  is  occasion  in  the  play  or  work  of  the  pupils.  Es- 
pecially desirable  is  individual  instruction  when  it  is  needed. 
The  teacher  who  advises  a  pupil  who  is  anemic  to  walk  to 
school  rather  than  to  ride  in  a  closed  car,  and  who  afterward 
follows  this  up  to  see  that  it  is  done,  has  no  doubt  accom- 
plished more  for  the  good  of  the  child  than  would  have  been 
possible  through  any  given  class  instruction  for  a  year.  In 
caring  for  children  who  have  wet  feet,  in  supervising  the 
warming  and  eating  of  lunches  at  noon,  in  advising  children 
who  have  colds  of  the  best  methods  of  treatment,  the  teacher 
may  work  most  effectively. 

(7)  In  matters  pertaining  to  hygiene,  children  should  be 
taught  and  be  led  to  act  socially  for  the  good  of  the  group. 
To  obey  the  laws  of  health  is  desirable  not  merely  for  one's 
own  sake  but  for  the  good  of  others.  Mere  word  knowledge 
about  such  things  is  largely  worthless  unless  children  live  it 
in  the  home,  school,  and  community.  For  example,  children 
may  and  should  be  taught  that  there  is  danger  in  catching 
or  communicating  a  disease  through  the  common  drinking-cup, 
but  in  addition  to  this  the  teacher  must  see  that  individual 
drinking-cups  are  provided  and  used.  Every  teacher  should 
be  able  to  teach  children  how  to  make  a  drinking-cup  out  of 
a  piece  of  paper. 

(8)  Instruction  relative  to  the  effects  of  tobacco  and 
alcohol  on  bodily  health  has  probably  accomplished  but  little. 

'O'Sheu  &  Kellog's  Health  Series,  and  Coleman's  "The  People's  Health" 
(Macmillan);  Tolman's  "Hygiene  for  the  Worker"  (American  Book  Co.), 
and  Richard's  "Hygiene  for  Girls"  (Heath)  are  more  recent  texts  of  the 
new  order. 


HYGIENE   IN   ELEMENTARY   SCHOOLS  479 

These  topics  when  considered  in  the  upper  grades  should 
emphasize  particularly  the  economic  and  social  loss  to  the 
person  who  has  these  habits.  To  tell  boys  that  good  football- 
players  do  not  smoke,  and  that  nobody  who  drinks  can  be  an 
engineer  or  a  conductor,  is  probably  more  effective  in  influ- 
encing action  than  to  show  the  boys  pictures  of  ulcers  in 
the  stomach  due  to  the  excessive  use  of  alcohol.  The  most 
common  arguments  against  temperance  and  total  abstinence 
should  be  exploded  by  the  presentation  of  scientific  facts 
based  on  economics,  good  taste,  and  hygiene. 

(9)  While  a  knowledge  of  sex  hygiene  is  desirable  for 
children,  the  ordinary  teacher  who  has  had  no  special  scien- 
tific training,  and  has  Httle  or  no  sympathy  with  the  matter, 
is  not  at  all  fitted  to  teach  the  subject  with  success,  and  the 
probability  is  that  she  may  do  more  harm  than  good.  The 
proper  place  for  this  instruction  is  in  the  home.  Teachers 
should  lend  their  influence  toward  the  distribution  of  good 
literature  on  such  instruction  to  parents,  and  toward  the  en- 
couraging of  meetings  of  parents  where  such  matters  can  be 
talked  over.  Moreover,  as  more  skilled  teachers  of  nature 
study  and  biology  are  added  to  our  schools,  and  as  principals 
gain  more  scientific  knowledge  along  those  lines,  the  school 
may  gradually  meet  these  needs  that  are  at  present  not 
satisfactorily  met  by  all  the  homes.  The  present  study  and 
experimentation  in  this  field  promise  much  in  the  direction 
of  increased  socialization  of  the  school. 

(10)  Instruction  in  hygiene,  to  become  effective,  must 
plan  to  make  pupils  personally  responsible.  This  responsi- 
bility cannot  be  expected  unless  the  pupils  are  trained  in 
habits  that  make  for  health.  The  school  life  of  the  child 
offers  many  opportunities  for  cultivating  the  right  kind  of 
action.  Let  us  take  a  single  example.  Children  who  eat 
their  midday  lunches  in  the  schoolroom  are  likely  to  leave 
much  of  the  remains  on  the  floor  and  desks.  The  teacher 
should  insist  on  food  remnants  being  properly  taken  care  of 
until  finally,  through  pupil  organization  if  necessary,  pupil 


480  EDUCATIONAL  HYGIENE 

responsibility  is  assumed. ^  A  schoolhouse  and  grounds  that 
have  been  planned  from  the  point  of  view  of  hygiene  make  it 
easier,  of  course,  for  the  teacher  to  inculcate  the  right  kind 
of  habits.  A  poorly  lighted,  badly  ventilated  schoolroom, 
furnished  with  non-adjustable  seats,  and  a  muddy  school- 
yard do  not  make  for  good  habits.  An  investigation  of  the 
rural  schools  of  Worcester  County,  Mass.,  conducted  by  the 
State  Normal  School  at  Worcester,  shows  that  the  hygiene 
and  sanitation  of  these  schools  are  deplorable.  More  exten- 
sive investigations,  Uke  the  Ohio,  Wisconsin,  and  Vermont 
school  surveys,  show  that  these  conditions  are  common. 
But  even  under  the  most  unfavorable  conditions  the  ingenious 
and  intelligent  teacher  can  devise  many  ways  for  training 
the  children  in  good  habits.  Floors  may  always  be  swept, 
furniture  dusted,  the  window-shades  adjusted,  and  the  heat- 
ing and  ventilating  in  some  measure  controlled. 

(11)  In  the  selection  of  subject-matter,  stress  should  be 
laid  particularly  upon  the  most  important  health  problems  of 
the  community.  The  teacher  in  the  rural  schools  should  lay 
particular  emphasis  on  topics  in  rural  hygiene  such  as  "The 
Danger  of  Infection  from  Surface  Water,  Springs,"  etc.  A 
teacher  in  city  schools  would  find  topics  like  "Why  It  Is 
Better  to  Walk  Short  Distances  Rather  than  to  Take  a  Car" 
and  "The  Danger  from  a  Leaky  Gas-Tube,"  etc.,  more  valu- 
able. One  way  of  getting  at  these  problems  is  to  study  the 
health  needs  of  a  given  community,  matters  relative  to  water- 
supply,  sewerage,  etc.,  and  how  they  are  being  met.  The 
board  of  health  of  the  community  can  frequently  render 
valuable  assistance  by  showing  groups  of  pupils  or  teachers 
what  are  the  unmet  health  problems  of  the  community  and 
what  they  can  do  to  help  in  their  solution. 

(12)  The  education  of  the  children  in  hygiene  demands 
the  active  co-operation  of  parents.  Children  cannot  be  made 
healthy  through  the  mere  training  and  instruction  in  hygiene 
given  in  the  grades.     The  sanitary  and  hygienic  conditions 

'See  Scott's  "Social  Education." 


HYGIENE   IN   ELEMENTARY   SCHOOLS  48 1 

necessary  for  health  must  be  supphed  at  home  as  well  as  at 
school.  Hygienic  habits,  if  they  are  really  to  influence  the 
health  of  the  children,  must  be  not  merely  school  but  also 
home  habits.  School  principals  and  teachers  must  see  that 
the  parents  are  enlightened  as  well  as  the  children.  The 
parent-teacher  association  movement  which  is  now  becoming 
so  popular  ought  to  be  an  excellent  way  of  bringing  parents 
and  teachers  together  to  co-operate  for  the  health  of  the  child. 
In  such  meetings  physicians  and  nurses  might  be  called  upon 
to  talk  to  and  with  parents  on  home  hygiene.^ 

(13)  The  practise  of  hygiene  should  be  fostered  and  ap- 
proved in  much  the  same  way  as  any  of  the  required  and  im- 
portant work  of  the  school.  The  teacher  praises  the  child 
for  excellence  in  arithmetic  or  geography  and  gives  him  a 
high  mark  on  his  report-card.  Should  not  practise  in  hygiene 
be  praised  and  marked  in  the  same  way?  The  practise  of 
hygiene  is  of  fundamental  importance  and  it  should  have 
equal  opportunities  for  success  with  the  other  subjects  of 
the  curriculum.  I  realize  that  this  suggestion  is  radical  and 
that  our  system  of  marking  is  defective;  nevertheless,  I  be- 
lieve it  would  be  a  means  of  improving  hygienic  practise. 

IV.  Methods  of  Teaching  Hygiene. — (a)  Incidental. — As 
previously  suggested,  we  need  to  judge  the  results  of  the 
teacher  of  hygiene  largely  by  the  habits  which  she  has  been 
able  to  inculcate.  In  one  sense  the  schoolroom,  the  school 
grounds,  and  the  home  are  to  be  considered  as  places  for  the 
practise  of  hygienic  habits.  Every  opportunity  that  the 
teacher  has  to  help  the  child  to  form  the  right  kind  of  habit 
should  be  eagerly  seized.  It  is  quite  absurd  to  think  of 
different  habits,  all  important  to  health,  being  taken  up  in 
certain  grades  in  a  mechanical  fashion  and  then  being  allowed 
to  drop.  It  is  not  sufficient  to  mention  cleanliness  in  one 
grade,  or  to  make  a  great  crusade  for  cleanliness  at  this  time, 
and  then  let  it  drop  and  begin  on  another  habit  in  the  next 

'Professor  W.  H.  Heck,  "Parents'  Part  in  School  Hygiene,"  Educational 
Review,  February,  19  r4.     See  also  Appendix  II. 


482  EDUCATIONAL  HYGIENE 

grade.  It  is  well  to  remember,  too,  that  there  is  no  general 
habit  of  cleanliness.  A  child  may  have  clean  teeth  and  not 
have  clean  finger-nails.  General  cleanliness  is  gained  only 
through  the  practise  of  specific  habits  of  cleanliness  and  the 
development  of  propulsive  health  ideals. 

Instruction  in  and  practise  of  habits  necessary  for  health 
should  take  place  as  soon  as  the  child  enters  school.  In  most 
cases  this  instruction  should  be  incidental  and  individual. 
In  some  cases,  as  in  the  cleaning  of  the  teeth,  class  instruc- 
tion should  be  given  and  tooth-brush  drills  inaugurated.  As 
soon  as  the  habit  is  being  practised  regularly,  nothing  further 
need  be  done  except  in  individual  instances.  Sometimes  the 
entire  school  may  come  from  homes  where  they  are  taught 
to  clean  their  teeth  regularly.  In  such  circumstances  the 
teacher  would  not,  perhaps,  find  it  necessary  to  give  the  mat- 
ter much  consideration.  When  lessons  are  given  in  the  lower 
grades  they  should  be  brief,  simple,  and  in  a  conversational 
tone.  The  first  four  grades  should  centre  their  forces  on 
getting  children  to  form  essential  habits  and,  eventually,  on 
making  the  pupils  responsible  for  them.  Reading  and  a  more 
systematic  treatment  of  the  subject  should  come  in  the 
higher  grades. 

Among  the  many  good  habits  which  the  teacher  should 
supervise  to  a  certain  extent  in  the  school  are:  (i)  cleanliness 
of  body  and  cleanliness  in  the  schoolhouse  and  on  the  school 
grounds,  (2)  cleaning  the  teeth,  (3)  ventilating  the  school- 
room, (4)1  assuming  correct  postures,  (5)  I  correct  breathing, 
(6)  cleaning  shoes  before  entering  the  schoolroom,  (7)  correct 
use  of  the  voice,  (8)  right  use  of  the  eyes,  (9)  care  of  hair  and 
nails,  (10)  use  of  individual  drinking-cups,  pencils,  and  other 
materials,  (11)  dusting  school  furniture,  (i2)icleaning  black- 
boards, (13)  use  of  the  handkerchief,  etc.        ' 

There  are  also  some  bad  habits  which  should  be  discour- 
aged, such  as  (i)  (putting  things  into  the  mouth,  (2)  expec- 
torating on  the  floor,  (3) /biting  nails,  (4)  thumb-sucking, 
(5)  "swapping"  gum,  food,  etc.,  (6)  coughing  in  another's 


"Tooth-brush  drill,"  Boston  public  school,  Department  of  Hygiene 
Note  equipment  of  nurse's  room 


5^c"^5fw~r?i 


Inculcating  the  tooth-brush  habit  and  ideal  at  Cincinnati,  O. 


HYGIENE   IN   ELEMENTARY   SCHOOLS  483 

face,  (7)  kissing  on  the  lips,  (8)  carrying  soiled  handkerchiefs, 
(9)  picking  the  nose,  (10)  licking  the  lingers  in  turning  the 
pages  of  a  book,  (11)  reading  in  a  dim  light,  (12)  Irubbing  the 
eyes,  (13)  putting  foreign  bodies  into  the  ear,  (14)  cracking 
nuts  with  the  teeth,  (15)  overeating,  (16)  eating  when  tired, 

(17)  using  another  person's  brush,  comb,  towel,  drinking-cup, 

(18)  wearing  wet  clothing,  (19)  bandaging  a  cut  with  a  dirty 
cloth,  (20)  wearing  shoes  that  are  too  small,  (21)  negligence 
in  bathing,  (22)  getting  wet  feet,  etc. 

In  the  upper'  grades,  say  beyond  the  fourth,  it  is  to  be 
hoped  that  less  and  less  effort  will  be  necessary  on  the  part  of 
the  teacher  as  the  pupils  assume  more  and  more  the  responsi- 
bility. Incidental  instruction,  however,  will  always  be  neces- 
sary. 

Even  if  pupils  practise  certain  habits  while  at  school,  it 
does  not  necessarily  follow  that  they  will  practise  them  at 
home;  and  then  there  are  many  habits,  such  as  sleeping  with 
the  window  open,  that  cannot  well  be  practised  at  school. 
The  teacher  may  advise  children,  ask  them  to  report,  or 
possibly  confer  with  the  parent  to  get  the  child  to  act.  The 
deep-seated  prejudice  and  ignorance  found  in  many  homes 
interfere  greatly  with  the  teacher's  success  in  this  direction. 
Often  she  can  do  httle  but  give  advice  and  hope  that  it  will 
function.  All  associations  which  bring  teachers  and  parents 
together  to  talk  over  common  health  problems  should  be  en- 
couraged. 

The  teacher  in  co-operation  with  a  school  physician  and 
nurse  may  accompHsh  a  great  deal  to  make  parents  feel  a 
sense  of  responsibihty.  As  the  school  physician  is  not  in 
direct  contact  with  the  children  and  carries  certain  authority 
because  he  is  a  physician,  both  the  children  and  the  parents 
in  many  cases  are  more  likely  to  respond.  If  they  do  not,  a 
school  nurse  may  be  sent  directly  to  the  home  to  advise  the 
parents  and  to  see  personally  that  the  children  ha\'e  proper 
care.  To  make  the  work  of  the  school  physician  and  school 
nurse  effective,  however,  the  teacher's  intelligent  co-operation 


484  EDUCATIONAL  HYGIENE 

is  necessary.  She  must  be  quick  to  see  that  there  is  something 
wrong  and  refer  the  case  to  the  physician.  The  result  in 
most  cases  is  hkely  to  further  the  interests  of  school  work. 
Often  it  is  backwardness  in  school  which  suggests  that  there 
is  something  wrong  with  the  health  of  the  child.  When  that 
is  corrected,  the  school  work  almost  invariably  improves. 
Whenever  a  child  is  backward  without  any  apparent  cause,  he 
should  always  be  turned  over  to  the  physician. 

The  Massachusetts  State  Board  of  Education  has  issued  a 
pamphlet  which  should  be  very  helpful  to  teachers.  The 
general  symptoms  which  would  justify  sending  a  pupil  to 
the  school  physician,  according  to  this  pamphlet,  are  as  fol- 
lows: (i)  emaciation,  (2)  pallor,  (3)  puffiness  of  the  face, 
(4)  shortness  of  breath,  (5)  swellings  in  the  neck,  (6)  general 
lassitude  and  other  evidences  of  sickness,  (7)  flushing  of  the 
face,  (8)  eruptions  of  any  sort,  (9)  a  cold  in  the  head  with 
running  eyes,  (10)  irritating  discharge  from  the  nose,  (11)  evi- 
dences of  sore  throat,  (12)  coughs,  (13)  vomiting,  and  (14)  fre- 
quent requests  to  go  out.^ 

All  educators  and  physicians  now  realize,  I  believe,  that 
the  teacher  should  not  attempt  to  diagnose  a  trouble;  she 
should  be  able  to  recognize,  however,  that  something  is  wrong. 
Normal-school  students  as  a  part  of  their  professional  work 
in  hygiene  should  study  the  different  ways  in  which  they  can 
co-operate  with  the  medical  inspector  and  nurse.  Such  a 
study  should  include  in  part  the  actual  observation  of  the 
medical  inspector  and  nurse  at  work,  assisting  where  possible. 

Not  only  should  the  teacher  co-operate  with  the  medical 
inspector  and  nurse  but  she  should  also  co-operate  with  chari- 
table institutions  and  the  home  so  that  sick  or  defective  chil- 
dren may  be  properly  cared  for.  As  an  illustration  of  the 
right  kind  of  co-operative  effort  I  quote  from  the  records  of 
the  Elizabeth  Street  School,  Worcester,  Mass.: 

•  See  also  list  of  symptoms  given  on  page  215. 


Hygiene  in  elementary  schools  485 


Winter  of  191 2-13 

H.,  boy  of  thirteen  years,  anemic,  nervous,  undersized,  with 
greatly  enlarged  glands,  had  grippe  which  left  him  with  hard  cough 
and  in  a  weakened  condition.  His  school  work,  was  so  poor  the 
teacher  reported  the  case  to  the  medical  inspector,  thinking  that  it 
might  be  best  to  take  the  child  out  of  school. 

A  tonic  was  recommended,  milk  and  fresh  eggs  were  obtained 
through  the  Anti-tuberculosis  Society,  and  part-time  attendance  was 
permitted  for  the  remainder  of  the  year.  At  the  request  of  the  medical 
inspector  and  after  a  conference  with  the  mother,  this  boy  was  taken 
to  the  City  Hospital.  An  examination  showed  tubercular  infection 
in  one  lung,  and  other  symptoms.  By  appealing  to  a  charitable  or- 
ganization, an  arrangement  was  made  whereby  he  was  sent  to  the 
country  for  the  summer. 

H.  returned  to  school  in  better  condition  than  he  has  ever  been  in 
before;  is  doing  good  work  in  class,  receiving  the  last  term  the  best 
report  he  ever  had. 

As  a  result  of  conferences  with  the  mother,  the  boy  is  now  able  to 
sleep  with  his  windows  open  and  be  out  of  doors  a  good  deal.  He  is 
examined  at  intervals  by  the  school  physician,  who  reports  that  he  is 
now  in  an  excellent  physical  condition. 

Spring  of  1914:  H.  has  entered  trade  school,  is  in  good  health  and 
is  doing  good  work. 

This  is  a  kind  of  work  in  hygiene  that  counts. 

Medical  inspection,  if  it  is  to  further  the  health  of  the 
school-children,  must  do  something  besides  "inspect."  It 
must  follow  up  cases  to  see  that  they  are  properly  treated. 
The  ordinary  notice  sent  to  the  parent,  unless  it  is  followed 
up  as  in  the  case  mentioned  above,  is  generally  useless. 
Doctor  Storey  has  demonstrated  the  value  of  a  "follow-up 
method"  in  the  secondary  and  lower  collegiate  department 
of  the  College  of  the  City  of  New  York.  This  plan  of  in- 
dividual instruction  in  hygiene.  Doctor  Storey  says,  proved 
effective  in  90  per  cent  of  the  cases.  Although  there  are 
probably  many  more  obstacles  in  connection  with  an  ele- 
mentary school,  yet  there  is  no  reason  why  a  similar  method 
should  not  be  employed  with  a  great  improvement  over  the 
present  prevalent  practise. 


486  EDUCATIONAL   HYGIENE 

Another  way  of  teaching  hygiene  incidentally,  one  which 
is  seldom  made  use  of,  is  to  treat  in  the  schoolroom  all  simple 
emergencies  that  arise.  This  should  be  done  for  the  sake  of 
the  health  of  the  children  and  to  give  them  some  valuable 
ideas  on  hygiene.  Many  children  have  no  idea  of  antiseptics. 
If  a  cut  or  burn  is  treated  in  the  sc"hool,  such  information 
may  be  given  so  that  it  may  be  remembered.  There  is  no 
reason  why  children  should  not  be  taught  how  to  bandage  a 
finger  or  hand.  When  skill  has  been  gained  in  doing  this 
in  a  class  exercise,  they  will  then  be  able  with  the  teacher's 
supervision  to  put  on  a  bandage  in  an  actual  case  of  emer- 
gency. A  simple  emergency  outfit  can  be  purchased  for  a 
sHght  expenditure.  One  of  these  outfits  should  be  on  hand 
in  every  school-building,  especially  in  a  rural  school-building 
where  the  home  and  physician  are  often  some  distance  away. 
An  inexpensive  emergency  outfit  which  can  be  purchased  at 
any  good  drug-store  is  indicated  below: 

Emergency  Outfit 

Bandages,  one-inch,  for  fingers  and  toes,  30  cents  a  dozen;  one-inch, 
for  extremities,  40  cents  a  dozen. 

Absorbent  cotton,  27  cents  a  pound. 

Sterile  gauze  pads,  for  use  as  sponges  or  as  wet  dressings,  one 
dozen  in  a  package,  30  cents. 

Zinc  oxide  adhesive  plaster,  to  draw  edges  of  cuts  together  and 
hold  dressings  on,  one-half  inch  by  ten  yards,  40  cents  a  roll. 

Flexible  collodion,  one-ounce  bottle  with  brush  to  apply,  18  cents. 

Creolin,  Pearson's,  one  pound,  75  cents.  (One  teaspoonful  in  one 
pint  of  water  makes  antiseptic  solution.) 

Tincture  of  iodine,  two  ounces  with  brush  to  apply,  10  cents. 

Aromatic  spirits  of  ammonia,  four  ounces,  about  25  cents.  (For 
faintness,  fifteen  drops  in  a  tablespoonful  of  water.  Repeat  in  five 
minutes  if  necessary.) 

Carron  oil,  six  ounces,  about  20  cents.     (Apply  to  burns.) 

Witch-hazel,  six  ounces,  about  20  cents.     (For  sprains.) 

Borax,  5  cents. 

Oil  of  cloves,  two  ounces,  20  cents. 

Rubber  hot-water  bottle.  A  common-size  glass  bottle  is  as  good 
and  far  cheaper. 


HYGIENE   IN  ELEMENTARY   SCHOOLS  487 

Safety-pins,  small  and  large. 

Scissors. 

May  have  in  addition: 

Essence  of  peppermint.  (One-half  teaspoonful  in  one-half  cup  of 
hot  water  for  colic,  or  a  pinch  of  red  pepper  in  hot  water.) 

Soda  bicarbonate  tablets,  gr.  v.     (For  sour  stomach  and  vomiting.) 

Spirits  camphor.     (To  rub  on  swellings  where  skin  is  unbroken.) 

This  complete  outfit  can  be  purchased  at  any  good  drug-store  for 
about  I4.  If  conditions  make  this  expense  impossible,  every  teacher 
may  have  a  simple  outfit  to  treat  cuts,  burns,  and  bruises  for  a  small 
sum.  It  should  be  put  into  a  substantial  wooden  box  and  kept  under 
lock  and  key. 

Two  books  of  invaluable  assistance  to  every  teacher  in  dealing 
with  emergencies  are:  "Emergencies,"  Gulick,  "Hygiene  Series," 
(Ginn  &  Co.);  Barton,  "First  Aid  Text-book"  (published  by  First- 
Aid  Association  of  America,  Boston). 

Incidental  instruction,  which  may  not  be  directly  related 
to  immediate  action,  should  also  be  touched  upon  in  other 
lessons.  Health  is  so  related  to  all  the  experiences  of  life 
that  it  may  be  considered  in  this  fashion  without  a  thought 
of  "dragging  it  in."  Let  us  note  a  few  examples.  In  his- 
tory, children  should  be  taught  to  perceive  the  progress  that 
has  been  made  in  overcoming  disease,  new  discoveries  in 
medicine  and  hygiene,  and  the  effect  of  these  on  society;  in 
civics,  activities  pertaining  to  public  health,  such  as  the 
cleaning  of  the  streets,  the  disposal  of  garbage,  and  the  pre- 
vention of  the  spread  of  disease,  should  be  emphasized;  in 
geography,  the  failure  or  success  of  man  to  conquer  his  en- 
vironment through  the  neglect  or  practise  of  modern  sanita- 
tion is  important,  such,  for  example,  as  the  French  and 
American  methods  at  Panama;  in  nature-study,  many  oppor- 
tunities are  offered  to  teach  the  structure  and  functions  of  the 
human  body  by  comparing  man  with  the  plant  and  animal 
world.  Knowledge  thus  gained  helps  to  make  the  child  feel 
the  importance  of  health. 

(b)  Systematic  Instruction. — It  is  only  fair  to  ask  why,  if 
habit  is  the  real  goal  of  instruction  in  hygiene,  systematic  in- 
struction needs  to  be  given.     Personally,  I  believe  there  is 


488  EDUCATIONAL   HYGIENE 

little  place  for  it  below  the  fourth  or  fifth  grades,  and  not  even 
in  the  higher  ones  unless  it  centres  about  the  interests  of  the 
children.  In  the  upper  grades  its  purpose  should  be  that  of 
supporting  the  hygienic  habits  which  the  children  are  learning 
or  have  learned.  It  should  also  give  them  some  sort  of  an 
appreciation  of  health  as  one  of  the  assets  of  our  civilization. 
This  general  purpose  of  appreciation  must  be  characteristic 
of  much  that  is  taught  in  our  public  schools.  For  example,  a 
large  proportion  of  the  children  who  study  about  the  mining 
of  coal  or  the  manufacture  of  steel  will  never  make  their 
living  in  those  industries,  and  coal  would  burn  just  as  well 
without  any  knowledge  of  how  it  came  into  being.  A  knowl- 
edge of  both  coal  and  iron  does  help  to  broaden  the  social 
consciousness  of  the  child.  It  enables  him  to  see  these  in- 
dustries in  relation  to  the  needs  and  achievements  of  the 
people. 

For  a  similar  reason  systematic  instruction  in  hygiene 
should  be  given,  only  in  this  case  hygiene  is  much  more  im- 
portant as  a  social  problem  and  is  something  which  the  citizen 
can  influence  to  a  large  extent  by  his  voice  and  vot^and  action. 

Fortunately,  at  this  time  there  are  a  number  of  good  text- 
books in  hygiene  available  for  children  in  the  grades.  Among 
such  books  the  Gulick  "Hygiene  Series"  (Ginn  &  Co.)  seems 
to  the  writer  to  be  most  interesting  to  children.  In  this  brief 
paper  it  is  impossible  to  discuss  the  ways  in  which  such  books 
can  best  be  used.  Every  teacher  should  have  on  hand  a  few 
books  for  ready  reference.  The  busy  teacher  who  wishes  to 
get  a  general  background  of  physiology  and  anatomy  with  their 
application  to  hygiene  will  find  Coleman's  "Hygienic  Physiol 
ogy  "  (Macmillan)  excellent.  A  larger  and  heavier  work  along 
the  same  lines  is  Hough  and  Sedgwick's  "The  Human  Mech- 
anism" (Ginn  &  Co.).  Every  teacher  should  have  on  her 
desk  a  good  book  on  school  hygiene.  Hoag  and  Terman's 
"Health  Work  in  the  Schools"  (Houghton,  Mifflin)  and  Dress- 
lar's  "School  Hygiene"  (Macmillan)  are  probably  the  best. 
Terman's  "The  Hygiene  of  the  School  Child"   (Houghton, 


HYGIENE   IN   ELEMENTARY    SCHOOLS  489 

Mifflin)  is  almost  indispensable.  Ditman's  "  Home  Hygiene 
and  the  Prevention  of  Disease  "  (Duffield)  is  probably  the 
best  book  to  recommend  to  parents. 

Besides  such  material,  which  may  be  permanently  avail- 
able, the  current  newspapers  and  magazines  contain  abundant 
material  which  the  teacher  may  inject  into  the  lessons.  Some 
of  the  magazines  have  excellent  pictures  in  their  regular 
reading  columns  or  in  the  advertising  section,  which  may  be 
used  effectively.  In  the  upper  grades  the  teacher  may  find 
it  advantageous  to  have  a  bulletin-board  on  which  the  chil- 
dren may  put  printed  matter  of  interest. 

The  tendency  in  teaching  hygiene,  as  in  all  other  subjects, 
has  been  to  emphasize  the  acquisition  of  mere  knowledge. 
This  is,  of  course,  to  be  deplored.  Subject-matter  should  be 
selected  with  reference  to  its  probable  power  to  promote 
healthy  ideals,  practical  knowledge,  and,  most  important  of 
all,  habits  necessary  for  health.  In  the  last  analysis  the 
value  of  the  work  in  hygiene  must  be  judged  by  the  number 
and  value  of  the  hygienic  habits  which  pupils  have  formed. 

V.  An  Effective  Ideal  of  Health. — The  psychology  of 
ideals  is  still  a  dark  chapter  in  our  modern  psychology.  Many 
teachers  and  parents  are  misled  in  the  belief  that  mere  word 
knowledge,  even  when  coupled  with  considerable  understand- 
ing, functions  through  ideals.  A  child  may  have  a  good  deal 
of  knowledge  about  the  structure,  function,  and  care  of  his 
teeth  and  still  never  use  a  tooth-brush.  Knowledge  is  use- 
ful in  inculcating  the  right  habits  but  it  is  insufficient.  The 
idea  of  the  care  of  the  teeth  must  have  back  of  it  a  desire  to 
have  clean  teeth,  otherwise  the  child's  knowledge  becomes 
mere  formal  intellectual  propositions.  Knowledge  presented 
so  as  to  touch  the  child's  interests  and  ambitions  does  fre- 
quently function,  but  our  effective  ideals  probably  develop 
in  most  cases  through  habits  of  action.  It  is  questionable 
whether  many  gain  the  ideal  of  work  after  knowing  the  value 
of  work.  The  effective  ideal  of  work  usually  comes  through 
habits  of  industry.     Likewise  ideals  of  cleanliness  are  acquired 


490  EDUCATIONAL  HYGIENE 

through  habits  of  being  clean.  The  first  step  toward  getting 
children  to  develop  the  ideals  of  health  is  to  get  them  to  form 
the  right  habits.  Attractive  knowledge  of  the  right  kind  will, 
of  course,  tend  to  make  the  practise  of  the  habit  easier.  The 
inspiration  and  example  of  the  teacher,  too,  are  always  pow- 
erful incentives  to  habit-formation.  Out  of  these  hygienic 
habits,  ably  supported  by  a  knowledge  of  the  value  of  hygienic 
living,  there  should  grow  an  effective  ideal  of  health  for  the 
pupil  who  is  to  be  thrown  on  his  own  responsibility  in  facing 
the  problems  of  life. 

y^^\.  Suggestions  for  Teachers.^ — (i)  The  conservation  and 
improvement  of  the  health  of  the  children  should  be  your  first 
consideration. 

(2)  Make  the  hygiene  and  sanitation  of  the  school  house 
and  grounds  as  satisfactory  as  possible. 

(3)  Try  to  improve  the  home  conditions  under  which  the 
^children  live  by  getting  the  co-operation  of  the  parents. 

(4)  Give  the  children  information  incidentally  whenever 
needed.  Systematic  instruction  should  be  given  in  the 
upper  grades. 

(5)  Present  information  that  is  allied  to  the  child's  in- 
terests. If  the  subject-matter  is  not  in  itself  attractive, 
associate  it  with  something  that  is  of  interest.  Appeal  to 
some  incentive  that  will  make  pupils  anxious  to  gain  more 
knowledge  of  the  subject. 

(6)  Teach  only  the  anatomy  and  physiology  that  are  neces- 
sary to  enable  the  pupils  to  practise  hygiene  better  and  to 
give  them  a  common-sense  idea  of  the  structure  and  functions 
of  the  body. 

(7)  Subject-matter  should  be  chosen  with  reference  to  in- 
spiring health  ideals  and  the  promotion  of  the  practise  of 
hygiene. 

(8)  Get  children  to  study  the  sanitary  and  hygienic  prob- 
lems of  the  community  and  its  success  or  failure  in  their 
solution. 

(9)  Study  the  individual  children  to  discover  any  symp- 


HYGIENE   IN   ELEMENTARY   SCHOOLS  49 1 

toms   of  illness   or   physical   defects.     Promptly   refer   such 
cases  to  the  school  physician,  nurse,  or  parents. 

(10)  Follow  up  every  case  to  see  that  it  is  properly  treated. 
If  necessary,  get  the  assistance  of  the  home  or  charitable  or- 
ganizations. 

(11)  Train  the  children  in  hygienic  habits  in  the  school. 
Try  to  get  the  children  to  practise  specific  habits  at  home  by 
securing  the  co-operation  of  the  parents. 

(12)  Get  the  child  to  put  into  practise  his  knowledge  of 
hygiene  whenever  the  opportunity  presents  itself. 

(13)  Carefully  supervise  every  habit  in  the  early  stages  of 
its  formation.  Insist  on  practise  until  the  act  has  become 
automatic. 

(14)  Plan  to  make  the  pupils  eventually  responsible  for 
the  practise  of  certain  specific  habits. 

(15)  In  approving  or  disapproving  the  child's  work  in 
hygiene  always  consider  the  practise  of  hygiene.  If  you 
mark  the  child  for  his  knowledge  of  hygiene,  mark  him  also 
for  his  practise.     Practise  is  more  important  than  knowledge. 

A  Health  Programme  for  Country  Children.^ — In  their  ef- 
forts to  improve  hygienic  conditions  in  the  schools  and  in 
the  community,  teachers  frequently  find  some  assistance  in 
a  simply  worded  health  programme  or  creed  for  the  indi- 
vidual child  to  apply  to  his  own  experience.  The  follow- 
ing is  not  intended  as  a  final  or  exhaustive  statement  of 
such  a  programme,  but  it  is  believed  that  by  means  of  it 
the  rural  teacher  may  be  able  to  drive  home  certain  fun- 
damentals in  hygiene  and  sanitation  that  will  ultimately 
mean  much  for  good  health  in  home,  school,  and  community 
and  make  a  direct  contribution  to  the  movement  for  better 
schoolhouses  in  the  country.  It  is  assumed  that  the  teacher 
will  select  such  of  these  items  as  seem  most  useful  for  her 
purpose  and  supplement  them  with  illustrative  examples 
from  real  life. 

'  By  Professor  i*.  B.  Dresslar,  from  his  government  bulletin  on  Sanitary 
Schoolhouses  and  Grounds. 


492  EDUCATIONAL  HYGIENE 


LEST  I  FORGET 

I  believe  that  good  health  and  a  strong  body  are  essential,  and 
that  the  only  real  wealth  is  good  health.  In  order  that  I  may  be 
strong  and  well,  therefore,  I  will  endeavor  to  observe  the  following 
rules  of  health: 

1.  I  will  keep  my  teeth  clean  by  using  my  tooth-brush  every  day. 

2.  I  will  drink  no  coffee  or  tea  before  I  am  twenty  years  of  age, 
and  no  sort  of  alcoholic  stimulants  at  any  time  in  my  life,  unless 
ordered  to  do  so  by  a  physician. 

3.  I  will  chew  my  food  thoroughly. 

4.  I  will  sleep  at  least  nine  hours  each  night  in  well-ventilated 
rooms  winter  and  summer,  or  in  an  open-air  sleeping  porch. 

5.  I  will  bathe  my  whole  body  at  least  once  a  week  and  keep 
my  face,  hands,  and  nails  clean. 

6.  I  will  strive  daily  to  acquire  a  habit  of  self-control,  habits  of 
anger  being  not  only  wrong  but  unhealthful. 

7.  I  will  strive  to  help  make  my  home  as  clean  and  sanitary  as 
possible,  especially  to  prevent  contamination  of  the  milk  and  drinking 
water. 

8.  I  will  do  all  I  can  to  prevent  the  development  of  flies  about 
the  house  in  which  I  Hve,  since  they  carry  the  germs  of  typhoid  fever 
and  other  diseases. 

9.  I  will  do  all  in  my  power  to  prevent  mosquitoes  from  breeding 
in  or  about  the  house  I  live  in.  I  will  bury  or  destroy  all  old  tin 
cans,  barrels,  or  other  vessels  which  catch  and  hold  rain  water  and 
offer  a  place  for  mosquitoes  to  breed.  I  will  help  to  drain  all  stag- 
nant pools  near  my  home  or  put  kerosene  oil  on  them  once  every 
ten  days  during  summer. 

10.  I  will  try  hard  to  kill  all  rats  and  mice  about  my  home,  since 
they  are  both  troublesome  and  dangerous,  carrying,  among  other 
things,  the  bubonic  plague,  one  of  the  most  deadly  of  all  diseases. 

11.  I  will  do  all  in  my  power  to  help  secure  sanitary  toilets  through- 
out the  whole  neighborhood. 

12.  I  will  strive  to  keep  the  back  yard  of  my  house  as  clean  and 
tidy  as  a  front  yard  should  be  kept. 

13.  I  will  take  no  patent  medicine,  and  will  do  all  I  can  to  teach 
people  that  most  of  it  is  both  useless  and  harmful. 

14.  I  will  keep  my  personal  life  clean  and  pure,  for  it  is  a  duty 
I  owe  to  myself  and  to  all  who  live  now  and  may  live  in  the  future. 

15.  I  will  take  good  care  of  my  eyes,  taking  special  pains  not  to 
gtrain  them  by  reading  at  night  or  in  bad  light, 


HYGIENE   IN   ELEMENTARY   SCHOOLS  493 

16.  I  will  be  careful  about  spitting,  since  disease  is  often  spread 
in  that  way. 

17.  I  will  do  all  I  can  to  help  make  our  schoolhouse  more  attract- 
ive and  to  keep  it  clean  and  neat  at  all  times. 

18.  I  believe  the  best  investment  I  can  make  for  myself  and  my 
family  is  to  invest  in  good  health,  a  good  education,  and  a  clean  moral 
life. 

19.  I  will  strive  with  all  my  power  to  make  country  life  more 
healthful,  more  enjoyable,  and  more  beautiful.  I  believe  life  in  the 
country  is  finer  and  better  than  life  in  any  city. 


CHAPTER  XXVI 
HEALTH  TEACHING  IN  HIGH  SCHOOLS 

The  Need  for  Teaching  Hygiene. — The  great  Erasmus 
thought  that  natural  history  should  be  taught  in  the  schools 
in  order  that  the  pupils  might  understand  the  allusions  in  Vir- 
gil and  the  other  classic  poets  to  flowers,  animals,  and  other 
objects  in  nature.  A  distinguished  medical  practitioner  a 
few  years  ago  urged  the  teaching  of  physiology  and  hygiene 
in  high  schools  in  order  that  "patients  might  understand 
their  physician  better;  might  tell  him  better  about  their  ail- 
ments when  afflicted."  Both  Erasmus  and  this  modern 
physician  had  an  eye  to  direct  utility,  but  it  was  an  illusory 
utility  characteristic  of  intellectual  astigmatism.  The  reasons 
for  the  study  and  teaching  of  health  in  our  high  schools  are 
as  much  broader  and  more  fundamental  than  the  reason  al- 
leged by  the  physician  as  were  the  reasons  for  studying 
natural  phenomena  broader  and  more  fundamental  than  the 
reason  alleged  by  Erasmus.  In  both  cases  the  real  reason  is 
the  value  of  the  thing  itself. 

In  the  light  of  the  economic  and  ethical  relations  of 
health,'  its  place  in  education  takes  on  a  new  significance. 
Conservation  of  health  is  an  essential  end  of  education.  In 
the  elementary  school  this  end  is  attained  if  right  habits  of 
living  are  initiated.  In  the  high  school  something  more  is  re- 
quired. High-school  pupils  should  acquire  an  understanding  of 
basic  principles  of  hygiene,  both  personal  and  social;  and  the 
organization  of  health  instruction  and  health  practise  in  the 
high  schools  should  be  definitely  to  that  end.  This  does 
not  imply  that  the  work  of  habituating  to  right  living  will 

'  Rapeer,  "School  Health  Administration,"  chap.  I. 
494 


HEALTH   TEACHING   IN   HIGH   SCHOOLS  495 

have  been  completed  in  the  elementary  schools.  For  two 
reasons  this  is  impossible:  _^r5/,  because  habits  wait  upon  in- 
stincts and  capacities,  and  some  instincts  and  capacities  do 
not  mature  in  the  elementary  school  age;  second,  because  the 
administration  of  health  measures,  even  in  the  best  elementary 
schools,  is  so  far  from  perfect  that  a  large  part  of  the  pupils 
still  pass  through  without  acquiring  a  full  set  of  habits  of 
right  living.  Not  only  is  the  health  teaching  very  imper- 
fect, but  also  the  home  environment  is  frequently  not  con- 
ducive to  the  formation  of  health  habits.  "More  than  95  per 
cent  of  our  public-school  pupils  come  from  homes  where,  for 
one  reason  or  another,  they  fail  to  learn  some  things  pertaining 
to  their  bodily  welfare  that  every  person  ought  to  know."^ 
It  is  not  surprising,  therefore,  that  a  large  per  cent  of  high- 
school  entrants  are  short  on  habits  of  right  living.  In  the 
high  school  there  is  much  to  be  done  in  the  way  of  forming 
right  habits.  But  beyond  this  is  the  necessity  of  vitalizing 
habit  and  prescription  by  an  understanding  of  the  laws  and 
principles  of  hygiene. 

Status  of  Health  Teaching  in  the  Elementary  School.-^ 
The  problem  of  health  teaching  in  the  elementary  school  is 
fully  treated  in  the  preceding  chapter,  but  as  the  character  of 
health  teaching  in  the  high  school  depends  in  a  measure  upon 
the  character  of  the  health  teaching  in  the  elementary  school, 
a  brief  reference  to  that  matter  is  necessary  in  this  connec- 
tion. In  Massachusetts,  for  near  a  hundred  years,  the  neces- 
sity of  health  teaching  in  the  public  schools  was  agitated 
intermittently.  Results  were  meagre  and  unsatisfactory.^ 
It  was  not  until  1885,  under  the  stimulus  of  the  "scientific 
temperance"  propaganda,  that  the  teaching  of  health  became 
compulsory  by  statutory  enactm-ent.  With  local  variations 
of  time  and  emphasis,  the  history  of  Massachusetts  is  the 

'  Moseley,  "Some  Ways  of  Teaching  Practical  Hygiene,"  School  Science  and 
Mathematics,  January,  191 2,  p.  i  /. 

-  Towne,  Lillian  H.,  "  Problems  of  Teaching  Hygiene,"  U.  S.  Bureau  of  Ed- 
ucation Bulletin  No.  48,  1913,  "School  Hygiene,"  p.  74. 


496  EDUCATIONAL  HYGIENE 

history  of  most  of  the  other  States.  This  propaganda  aimed 
at  "temperance,"  not  at  physiology.  "In  all  grades  below 
the  high  school  this  instruction  should  contain  only  physiology 
enough  to  make  the  hygiene  of  temperance  and  other  laws  of 
health  intelligible.  Temperance  should  be  the  chief  and  not 
the  subordinate  topic  and  should  occupy  at  least  one-fourth 
of  the  space  in  text-books  for  these  grades."  ^  Within  fifteen 
years  practically  every  State  in  the  Union  had  enacted  laws 
requiring  the  teaching  of  physiology  and  hygiene,  "with 
especial  reference  to  alcohol  and  narcotics,"  in  all  the  ele- 
mentary public  schools. 

The  failure  of  the  movement  is  generally  conceded,  and 
the  reasons  for  failure  have  been  abundantly  set  forth.^  It 
aimed  to  prevent  the  use  of  alcohol  and  tobacco  by  teaching 
early  the  harmful  physiological  effects  of  these  drugs.  In 
its  fervor  for  the  cause  it  sadly  mixed  myth  and  science, 
sought  to  base  concrete  practise  upon  scientific  understanding 
instead  of  the  reverse,  and  preached  the  doctrine  of  fear  and 
negation.  The  increased  per-capita  consumption  of  both 
alcohol  and  tobacco  in  the  generation  during  which  "scientific 
temperance  instruction"  has  had  place  in  the  schools  is  sufl&- 
cient  proof  of  the  failure  of  the  specific  aim  of  the  movement. 

The  success  of  the  movement,  however,  has  not  been 
generally  recognized.  This  movement  carried  within  itself 
two  factors  pregnant  of  results.  First,  it  had  the  dynamic 
force  of  a  moral  idea.  The  moral  earnestness  of  the  "scien- 
tific temperance"  propaganda  that  within  half  a  generation 
wrote  its  laws  upon  the  statute-books  of  practically  every 
State  in  the  nation,  and  then  enforced  obedience  to  those  laws, 
is  now  coming  to  expend  itself  in  the  safeguarding  of  the 
health  of  school-children  and  in  developing  a  kind  of  health 
instruction  that  shall  l)uild  up  habits  of  hygienic  living  and 
create  a  health  conscience  among  the  children. 

'Billings,  J.  S.,  "Physiological  .\spects  of  the  Liquor  Problem,"  1903, 
vol.  I,  p.  23. 

=  Berry,  Charles  Scott,  "High  School  Education,"  ed.  by  Charles  Hughes 
Johnston,  p.  347/.  (Scribners,  191 2). 


HEALTH  TEACHING   IN   HIGH   SCHOOLS  497 

The  second  factor  is  found  in  the  declaration  of  principles 
quoted  above:  "This  instruction  should  contain  only  physiol- 
ogy enough  to  make  the  hygiene  of  temperance  and  other  laws 
of  health  intelligible."  Here  was  a  declaration  of  radical  im- 
portance. "Naming  the  bones"  has  been  the  butt  of  many  a 
jest  on  the  part  of  the  critics  of  the  old  text-book  physiology; 
but  up  to  the  time  of  the  "scientific  temperance"  movement 
no  better  doctrine  had  been  formulated  either  by  pedagogists 
or  scientists.  The  principle  was  not  observed  in  the  "  scientific 
temperance"  text-books.  For  the  most  part,  "temperance 
physiology"  was  merely  grafted  upon  the  old  books  and  old 
methods.  But  the  germinal  idea  had  been  found  and  it  was 
the  "scientific  temperance"  zealots  that  "fished  the  murex 
up,"  not  their  critics.  The  substantial  principle  of  health 
instruction  in  the  grades  is  increase  of  health.  The  methodo- 
logical principle  is  subordination  of  anatomical  and  physio- 
logical fact  to  the  laws  of  health.  In  only  a  few  of  the  best 
schools  does  the  teaching  of  health  conform  to  these  prin- 
ciples, but  almost  universal  lip-service  shows  the  direction  of 
the  wind.  Text-books  are  appearing  that  embody  these  prin- 
ciples.^ With  the  ideal  well  recognized  and  with  adequate 
teaching  material  available  there  is  no  excuse  for  the  per- 
sistence of  outworn  matter  and  methods.  In  writing  of  health 
teaching  in  the  high  school  one  may  assume  that  the  elemen- 
tary school  in  the  next  few  years  will  fulfil  reasonable  require- 
ments.^ 

^  It  may  not  be  invidious  to  mention  the  series  by  Gulick  (Ginn  &  Co.), 
Woods  Hutchinson  (Houghton  Mifflin  Co.),  Coleman  (The  Macmillan  Co.), 
Bibb  and  Hartmann  (The  World  Book  Co.).  In  these  books  the  laws  and 
practises  of  hygiene  are  made  intelligible;  there  is  abundance  of  illustrative 
data;  in  some  there  is  a  good  deal  of  simple  experimental  material;  commu- 
nity hygiene  is  recognized  and  emphasized;  anatomy  and  physiology  are  sub- 
ordinated to  hygiene. 

-  In  this  discussion  the  orthodox -organization  eight-year  grade  and  four-year 
high  school  is  assumed.  The  next  ten  years  will  see  a  rapid  modification  of 
this  scheme.  (See  "Economy  of  Time  in  Education,"  Bulletin  No.  38,  1Q13, 
of  the  U.  S.  Bureau  of  Education.)  The  reorganization  of  the  higher  grades  of 
the  elementary  school  will  make  possible  a  much  more  effective  teaching  of  all 
subjects  than  is  possible  under  the  present  organization. 


498  EDUCATIONAL   HYGIENE 

The  High  School  and  Community  Leadership. — The  Amer- 
ican high  school  is  our  most  interesting  educational  institu- 
tion not  only  because  of  its  essential  character,  "more  demo- 
cratic than  the  college  and  more  selective  than  the  elementary 
school,"  wherein  "manhood  and  womanhood  are  visibly 
budding,"  but  also  because  of  its  unprecedented  growth  and 
expansion  during  the  past  two  decades.  In  1 891-2  there 
were  in  the  United  States  4,158  schools  of  secondary  rank, 
16,329  teachers,  and  297,894  pupils.^  In  1911-12  the  numbers 
were,  respectively,  13,268  schools,  64,236  teachers,  1,246,827 
pupils.-  This  is  an  increase  of  more  than  300  per  cent  in  the 
number  of  pupils.  The  average  annual  increment  is>  nearly 
50,000.  Even  more  striking  is  the  acceleration  of  increase  in 
the  last  four  years  of  the  series:  72,000  in  1909,  and  131,501 
in  191 2.  The  increase  in  191 2  is  50  per  cent  greater  than  the 
average  of  the  three  years  next  preceding,  and  more  than  three 
times  as  great  as  the  average  of  the  preceding  twenty  years. 
The  proportion  of  high-school  pupils  to  the  total  school 
population  has  increased  threefold  in  that  time.  About  23 
per  cent  of  the  children  of  the  present  generation  receive  some 
high-school  education.  There  is  also  a  slow  but  steady  in- 
crease in  the  number  of  pupils  who  persist  through  the  four 
years  of  high  school.  In"  1906-7  there  were  89,882  pupils,  or 
12^  per  cent,  in  the  fourth  year;  in  1911-12  there  were  166,- 
266  pupils,  or  i2,y2  per  cent.  In  1890  the  high-school  students 
were  slightly  less  than  one-half  of  one  per  cent  of  the  total 
population  of  the  country;  in  191 2  a  Httle  more  than  1.3  per 
cent.^ 

The  significance  of  these  figures  lies  not  in  the  facts  of 
increase  but  in  the  potential  community  leadership  of  this 
rapidly  increasing  part  of  the  body  politic  that  receives  the 

' "  High  School  Education,"  ed.  by  Charles  Hughes  Johnston,  Introd. 
(Scribners). 

=  Rep.  United  States  Com.  Ed.,  1Q12,  vol.  2,  chap.  8. 

'Assuming  that  the  annual  increment  in  population  in  1911  and  1912  is 
about  the  same  as  for  the  two  decades  preceding. 


HEALTH   TEACHING   IN   HIGH   SCHOOLS  499 

impetus  of  high-school  education.  The  impact  upon  society 
of  this  stream  of  high-school- trained  citizens  becomes  inevi- 
tably more  massive.  Whether  it  shall  be  effective  in  propor- 
tion to  its  mass  depends  upon  the  character  of  the  high-school 
training.  Whether  it  shall  raise  the  health  standards  of  the 
community  in  proportion  to  its  possibihties  for  such  service 
depends  upon  the  emphasis  that  is  placed  in  the  high  school 
itself  upon  the  practise  and  the  study  of  health.  It  is  possible 
for  the  high  school  to  ignore  both  the  practise  and  the  teach- 
ing of  hygiene;  it  is  possible  for  bad  practise  to  nulHfy  good 
instruction;  it  is  also  possible  for  practise  and  instruction  to 
co-operate  in  safeguarding  and  promoting  the  vitahty  of 
pupils,  and  in  enlightening  their  understanding  with  respect 
to  the  significance  of  public  and  personal  hygiene.  Not  the 
least  of  the  problems  of  the  "new"  high  school  is  this  of 
building  up  a  public-health  conscience. 

The  Physical  Conscience. — It  has  been  pointed  out  many 
times  that  the  worship  of  Hygeia,  so  characteristic  of  the  Greek 
civilization,  and  so  repugnant  to  the  early  Christian  culture, 
has  revived  within  the  last  half-century.  The  modern  at- 
titude toward  health  is  something  more  than  admiration  for 
physical  strength,  grace,  and  beauty.  It  involves  also  the 
idea  of  duty,  the  duty  of  realizing  in  oneself  the  physical 
virtues  of  strength,  efficiency,  and  endurance.  These  are  es- 
sential to  the  achievement  of  the  "aesthetic,  intellectual,  and 
spiritual  development  to  which  our  own  age  aspires."^  It  is 
the  idea  of  duty  in  this  conception  that  justifies  us  in  speaking 
of  "  the  physical  conscience."  It  is  the  development  of  the 
physical  conscience  that  is  the  special  task  of  health  instruc- 
tion in  the  high  school.  Obviously  the  physical  conscience 
cannot  be  a  resultant  of  the  study  of  quadratic  equations, 
Latin  declensions,  and  Burke's  orations;  it  must  be  the  re- 
sultant of  hygienic  environment,  habituation  to  the  practises 
of  hygienic  living,  and  an  understanding  of  the  principles  of 
hygiene. 

'  Ibid.,  p.  346. 


500  EDUCATIONAL   HYGIENE 

The  Physical  Status  of  High-School  Pupils. — How  much 
the  development  of  the  physical  conscience  is  needed  is  ap- 
parent when  one  investigates  the  physical  status  of  high- 
school  pupils;  and  even  more,  perhaps,  when  one  examines 
their  health  ideas  and  ideals.  The  records  of  physical  ex- 
amination show  a  large  amount  of  defect  and  ailment  among 
high-school  pupils;  examination  of  their  health  ideas  and 
ideals  shows  an  appalling  amount  of  ignorance  of  both  per- 
sonal and  public  hygiene  and  an  equally  appalling  amount 
of  complacency  with  respect  to  ill  health.  Many  exhibit  an 
almost  fatalistic  acceptance  of  physical  inferiority.  They 
recognize  neither  the  disgrace  of  being  weak  nor  the  duty  of 
being  strong. 

Casual  observation  of  high-school  pupils  shows  a  surpris- 
ingly large  amount  of  physical  imperfection.  Careful  phys- 
ical examination  fully  confirms  casual  observation.  Recent 
records  of  physical  examinations  in  Newark,  N.  J.,'  and  Wash- 
ington, D.  C.,^  are  probably  typical. 

In  Newark  during  the  years  of  1911-12  and  191 2-13  prac- 
tically all  of  the  high-school  pupils  of  both  sexes  were  given 
systematic  and  thorough  physical  examination.  The  Wash- 
ington record  is  of  284  girls  in  the  Eastern  High  School  of  that 
city.  In  Newark  the  physical  examination  showed  the  fol- 
lowing results  for  the  two  years: 

Average  number  of  pupils  examined 2,186 

Average  number  of  pupils  normal 802 

Average  number  of  pupils  with  defects 1,384,  or  63  per  cent 

The  average  total  number  of  defects  for  the  two  years 
was  2,204,  distributed  as  follows:  adenoids,  nasal  obstructions, 

*  Rapeer,  in  "The  Modern  High  School,"  ed.  by  Charles  Hughes  Johnston, 
chap.  XXVII. 

"^  Small,  W.  S.,  "Some  Results  of  Systematic  Physical  Examination  of  High 
School  Pupils."  Proceedings  Fourth  International  Congress  on  School  Hygiene, 
1913.     (Reprinted  in  The  School  Journal,  January,  1914.) 


HEALTH  TEACHING   IN  HIGH   SCHOOLS  50 1 

etc.,  loi;  defective  hearing,  103;  dental  defects,  740;  enlarged 
tonsils,  298;  visual  defects,  555;  enlarged  glands,  17;  heart 
defects,  102;  weak  lungs  (not  tuberculous),  22;  malnutrition 
and  debility,  78;  mentally  defective,  i;  nervous  affections,  5; 
defective  palate,  8;  orthopedic,  skeleton,  chest,  42;  spinal  de- 
fects, 19;  speech  defects,  5;  all  skin  ailments,  no. 

According  to  these  figures  two- thirds  of  the  high-school 
pupils  in  Newark  are  physically  defective.  This  does  not  take 
account  of  about  thirty  classes  of  ailments  not  reported  in  the 
returns.  This  is  a  larger  percentage  of  defect  than  is  found 
among  elementary-school  pupils,  according  to  Doctor  Rapeer.^ 
It  is  probable  that  there  is  exaggeration  in  the  Newark  figures 
of  the  number  of  cases  of  defective  hearing,  defective  vision, 
enlarged  tonsils,  heart  defects,  and  orthopedic  defects.  The 
ratio  of  these  per  1,000  pupils  is  so  much  greater  for  these 
high-school  pupils  than  for  elementary-school  pupils,  as 
estimated  by  Doctor  Rapeer,  upon  the  basis  of  extensive  and 
carefully  analyzed  data,  that  the  presumption  is  against  the 
accuracy  of  the  figures. 

In  the  case  of  vision  the  exaggeration  is  obvious,  as  the 
"standard  for  defective  vision  is  fixed  at  20/30  instead  of 
20/40,  which  permits  the  recording  of  many  minor  cases  of 
defective  vision  that  are  not  referred  for  glasses."  It  is 
likely  that  the  same  is  true  also  of  the  other  types  of  defect. 
On  the  other  hand,  it  is  not  improbable  that  the  examination 
of  these  high-school  pupils  is  more  thorough  than  that  or- 
dinarily given  to  elementary-school  pupils. 

The  physical-examination  record  of  284  girls  in  the  Eastern 
High  School  of  Washington  in  191 2-13  shows  general  corre- 
spondence with  the  Newark  record.  These  students  had  been 
in  school  from  one  to  four  years.  The  numbers  are  much 
smaller  than  the  Newark  numbers;  only  girls  are  concerned; 
and  the  examination  was  a  physical  rather  than  a  medical 
examination.  On  the  other  hand,  the  examinations  were 
semiannually  repeated.      The  girls  were  continuously  under 

» Ibid.,  p.  686. 


502  EDUCATIONAL  HYGIENE 

observation,  and  medical  examinations  were  made  in  doubt- 
ful cases.  The  examination  records  were  supi)lemented  by 
notes  of  observations.  They  are  a  fuller  chart  of  the  health 
of  the  individuals  concerned  than  are  the  Newark  records. 

Of  the  284  girls,  168  girls,  or  59  per  cent,  had  defects  of 
some  kind — 59  per  cent  as  compared  with  63  per  cent  in  New- 
ark. These  168  girls  had  a  total  of  378  defects,  an  average  of 
more  than  two  each.  The  recorded  defects  were  distributed 
as  follows:  eyes,  93;  ears,  24;  spine,  30;  heart,  29;  lungs,  2; 
nose  and  throat,  19;  enlarged  glands,  26;  developmental,  48; 
carriage,  71;  ankles,  36. 

These  two  sets  of  figures  show  a  large  amount  of  defect 
and  ailment  among  high-school  pupils.  The  type  and  fre- 
quency of  ailment  found  in  the  high  school  and  the  elementary 
school  are  similar,  and  point  to  an  urgent  need  of  enlighten- 
ment of  high-school  pupils  with  respect  to  health. 

The  significance,  however,  of  figures  in  regard  to  the  de- 
fects of  high-school  pupils  lies  not  chiefly  in  the  prevalence 
and  distribution  of  defects;  it  Hes  rather  in  improvement  and 
improvability.  The  correction  of  defects  and  the  improve- 
ment of  health  during  the  high-school  course  are  evidence  at 
once  of  effective  health  teaching  and  of  the  development  of 
the  physical  conscience.  The  persistence  of  remediable  de- 
fects may  be  no  reflection  upon  the  teaching,  but  it  is  in- 
fallible e\'idence  that  the  physical  conscience  has  not  been 
aroused. 

The  Newark  records  show  nothing  in  this  connection.  In 
the  Washington  school  the  record  of  corrections  is  as  follows: 
Of  the  378  defects  recorded  for  168  girls  cited  above,  116 
defects,  or  30  per  cent,  had  been  corrected  at  the  end  of  1913; 
and  of  the  168  girls  with  defects,  88,  or  52  per  cent,  had  had 
some  defects  corrected.  One-half  of  the  defects  of  the  fourth- 
year  class  had  been  corrected;  one-eighth  of  those  of  the  first 
year.  Thirty-five  girls  who  had  been  continuously  in  the 
school  for  four  years  show  the  following  record  of  correction 
of  defects: 


HEALTH   TEACHING   IN   HIGH    SCHOOLS 


503 


Year 

Number  of  girls 
with  defects 

Total  Number  of 
defects 

Number  of  defects 
corrected 

I 

35 
32 
29 
28 
35 

25 

72 
61 
56 
45 
79* 

40 

13 
7 

II 
8 

39 

39 

II 

Ill 

IV 

Total 

Number  at  end  of 
fourth  year 

*  Seven  new  defects  were  discovered  after  the  first  year. 

The  progressive  correction  of  defects  is  noticeable.  In 
this  fourth-year  group,  50  per  cent  of  the  defects  were  cor- 
rected and  30  per  cent  of  the  defectives  were  improved. 

On  the  other  hand,  the  number  of  remediable  defects  not 
remedied  is  eloquent  testimony  to  failure.  In  case  of  the 
35  girls  above  mentioned,  there  were  40  uncorrected  defects; 
only  6,  or  15  per  cent,  were  irremediable.  In  all  other  cases, 
the  pupils  didn't  care  enough  about  health  to  pursue  faith- 
fully the  regimen  that  would  have  corrected  the  defect.  Oc- 
casionally the  mental,  mind-stuff  theory  of  disease  stands  in 
the  way.  In  some  cases,  it  is  the  vulgar  fatalism  that  ac- 
cepts defect  as  a  matter  of  course.  More  frequently,  it  is 
mere  thoughtless  indifference — don't  want  to  take  the  trouble. 
In  still  other  cases,  vanity  rebels  against  the  necessary  pre- 
scriptions as  to  clothes,  shoes,  glasses,  etc.  Unhygienic  hab- 
its of  life  in  some  instances  are  so  deeply  rooted  that  a  com- 
plete revolution  in  respect  to  diet,  dress,  sleep,  exercise,  and 
work  would  be  required.  There  is  no  physical  conscience, 
no  appreciation  of  either  the  beauty  or  duty  of  health. 

Status  of  Health  Teaching  in  the  High  School. — Both  in 
character  and  extent  the  present  status  of  health  teaching  in 
the  high  school  is  unsatisfactory.  In  1910  Doctor  Gulick^  re- 
ported that  of  2,392  representative  high  schools  throughout  the 

'  Gulick,  L.  H.,  "Report  on  Status  of  Physical  Education  in  Normal  Schools 
and  High  Schools,"  Proceedings  Fourth  Congress  American  School  Hygiene 
Association,  1910,  p.  174. 


504  EDUCATIONAL   HYGIENE 

country,  only  16  per  cent  gave  regular  instruction  in  hygiene 
and  only  6  per  cent  had  i)hysical  examination  of  pupils.  In 
II  per  cent,  instruction  in  hygiene  was  compulsory.  Studies 
by  Crosby  1  and  Hunter ^  show  that  physiology  and  hygiene 
in  many  schools  are  taught  only  in  the  first  year  of  the  course, 
prior  to  the  study  of  any  basic  science.  The  method  and 
matter  are  merely  a  rehash  of  elementary- school  instruction. 
In  general,  the  subject  does  not  command  either  the  interest 
or  respect  of  the  pupils.  The  case  with  physical  training  is  no 
better.  Doctor  Gulick's  report  shows  that  only  8  per  cent 
of  the  high  schools  gave  regular  instruction  in  gymnastics. 
In  most  cases  the  instruction  is  formal  and  involves  little 
collateral  teaching  of  hygiene. 

There  are,  however,  encouraging  signs.  In  a  few  States 
health  instruction  is  compulsory  in  high  schools  as  well  as  in 
elementary  schools,  and  the  number  is  increasing.  The  rapid 
growth  of  medical  inspection  of  schools  and  the  development 
of  medical  inspection  into  health  supervision,  with  a  complete 
programme  of  health  promotion  and  control  in  all  the  public 
schools,  is  giving  a  new  impetus  to  health  teaching  in  the 
high  schools.  The  organization  of  health  instruction  in  high 
schools  is  making  progress.  There  is  still  need  for  propaganda, 
but  the  important  problem  is  the  content  and  method  of 
health  instruction. 

Lack  of  College  Credit. — It  is  alleged  that  failure  of  col- 
leges to  give  entrance  credit  for  physiology  and  hygiene  is 
one  reason  for  the  neglect  and  inefiQciency  of  the  teaching  in 
the  high  schools.  This  is  probably  true,  as  the  high  school 
has  been  and  still  is  strongly  influenced  by  college-entrance 
requirements.  In  general,  subjects  have  been  legitimized  in 
the  high-school  course  by  college  favor.  Other  subjects  have 
come  in  as  poor  relations  and  have  been  nurtured  accordingly. 

'  Crosby,  Clifford,  "Physiology,  How  and  How  Much?"  School  Science  and 
Malhcmatics,  vol.  7,  1907,  p.  738. 

-  Hunter,  G.  VV.,  "Biological  Science  in  Secondary  Schools,"  School  Science 
and  Mathematics,  vol.  5,  19 10,  p.  3. 


HEALTH  TEACHING   IN  HIGH   SCHOOLS  505 

Three  factors,  however,  are  likely  to  effect  a  change  with 
respect  to  hygiene.  The  first  of  these  is  the  essential  impor- 
tance of  the  subject  itself.  From  the  practical  standpoint  its 
importance  is  recognized  by  those  colleges  which  now  demand 
a  physical  examination  as  one  of  the  evidences  of  fitness  for 
college  entrance.  As  soon  as  it  is  recognized  that  systematic 
instruction  in  physiology  and  hygiene  has  practical  relations 
with  health  habits  and  ideals,  there  will  be  a  more  hospitable 
attitude  on  the  part  of  the  colleges.  The  second  factor  is 
germane  to  the  first — -the  colleges  are  rapidly  coming  to  recog- 
nize the  necessity  and  the  potency  of  health  instruction  in 
college.  The  necessity  is  frequently  attributed  to  the  failure 
of  the  lower  schools  to  provide  such  instruction,  which  is,  of 
course,  a  confession  that  the  high  school  ought  to  provide  it, 
*'In  1884  hygiene  was  taught  in  61  per  cent  of  the  46  leading 
colleges.  In  1909  it  was  taught  in  84  per  cent  of  the  116 
leading  colleges."  At  the  present  time  "80  per  cent  of  the 
colleges  offering  regular  courses  in  hygiene  give  positive  credit 
for  these  courses  toward  the  bachelor's  degree."  The  tend- 
ency is  for  all  college  subjects,  that  are  within  the  capacity 
of  the  early  adolescent  mind,  to  gravitate,  sooner  or  later,  into 
the  secondary  school.  Obviously  hygiene  is  of  this  class. 
The  third  factor  is  the  growing  tendency  of  colleges  to  accept 
for  entrance  credit  any  high-school  subject  that  is  valuable  and 
well  taught.  Successful  teaching  of  hygiene  in  strong  high 
schools  will  be  cogent  argument  for  college-entrance  recog- 
nition. On  the  other  hand,  recognition  by  the  colleges  would 
be  a  powerful  stimulus  to  sound  teaching  of  hygiene  in  the 
weaker  and  more  timorous  high  schools.  For  the  sake  not 
only  of  the  high  school  but  also  of  its  own  higher  efficiency, 
the  college  should  encourage  this  teaching  by  granting  en- 
tra^xe  credit. 

The  Locus  of  Health  Teaching  in  the  High-School  Course. 
— The  aim  of  health  teaching  in  the  high  school  as  stated  by 
Doctor  Berry  is  "to  give  the  pupil  a  scientific  knowledge,  as 
far  as  possible,  of  the  principles  of  physiology,  hygiene,  san- 


506  EDUCATIONAL  HYGIENE 

itation,  and  physical  education,  with  a  view  to  their  practical 
application.  But  if  this  aim  is  to  be  realized  the  pupil  must 
have  acquired  some  knowledge  of  biology,  and  should  also 
have  studied  chemistry  and  physics  before  beginning  the 
proposed  course  in  physiology  and  hygiene."  ^  This  means,  of 
course,  that  this  subject  must  be  placed  as  late  as  the  third 
year  of  the  course;  and,  as  most  high- school  courses  are  or- 
ganized, it  must  be  placed  in  the  fourth  year. 

This  is  partly  right  and  partly  wrong.  That  the  knowledge 
acquired  by  pupils  in  such  a  course  should  be  "scientific  as 
far  as  possible,"  is  self-evident.  That  instruction  in  hygiene 
and  physiology  must  be  delayed  until  late  in  the  course  on 
the  ground  that  the  study  of  biology,  chemistry,  and  physics 
is  a  prerequisite,  is  probably  both  impractical  and  unnecessary. 

The  plan  presupposes  that  these  three  sciences  are  pre- 
scribed for  all  pupils.  This  may  be  desirable,  but  there  is 
slight  probability  of  the  general  adoption  of  such  a  prescrip- 
tion. Even  were  it  adopted,  there  would  still  be  the  objection 
that  only  a  minority  of  high-school  pupils  would  be  reached. 
In  1906-7  the  distribution  of  high-school  pupils  for  the  nation 
was  as  follows:  fourth  year,  12.25  P^^  cent;  third  year,  18.17 
per  cent;  second  year,  27.23  per  cent;  first  year,  42.35  per  cent. 
There  is  a  constantly  increasing  persistence  of  high-school 
pupils,  as  is  shown  by  the  corresponding  figures  for  the  year 
1913-14:  fourth  year,  14.27;  third  year,  18.84;  second  year, 
26.75;  first  year,  40.14.2  Allowing  for  factors  other  than 
mortality,  it  is  certain  that  even  now  less  than  one-half  the 
pupils  who  enter  high  school  ever  reach  the  fourth  year.  If 
instruction  in  physiology  and  hygiene  is  as  important  as  we 
have  contended,  then  it  is  imperative  that  all  high-school 
pupils  should  have  the  benefits  of  such  instruction.  This  is 
recognized  by  those  States  which  require  this  teaching  in 
the  first  high-school  year.  There  must  be  health  instruction 
in  the  first  year,  but  this  does  not  exclude  further  instruction 

^Ibid.,  p.  357. 

^U.  S.  Bureau  of  Education,  Statistics  of  Public  and  Private  High  Schools. 


HEALTH  TEACHING   IN  HIGH   SCHOOLS  507 

in  subsequent  years.  There  should  be  continuous  teaching  of 
health,  collaterally  and  incidentally,  in  all  the  years  of  the 
course;  and  there  should  be  in  the  last  year  a  systematic 
course  in  physiology,  anatomy,  and  hygiene  utilizing  the 
knowledge  of  the  basic  sciences  that  may  have  been  acquired 
by  the  pupils,  the  experience  of  the  students  in  matters  of 
public  and  personal  hygiene,  the  data  of  physical  training,  the 
other  health  agencies  and  instrumentalities  of  the  school,  and 
the  public-health  agencies,  both  governmental  and  voluntary. 
There  is  a  great  deal  of  health  instruction  that  is  collateral 
to  other  subjects  and  incidental  to  school  life.  Wherever  facts 
and  principles  of  hygiene  are  germane,  they  should  be  taught. 
There  need  be  no  fear  of  wasteful  repetition.  Repetition 
under  varying  conditions  and  with  varying  associations  means 
organized,  vital  knowledge.  The  relation  of  air  and  health 
will  serve  as  an  illustration  of  direct  and  collateral  teaching. 
This  topic  may  be  taught  in  the  first-year  course  in  hygiene, 
in  chemistry,  in  biology,  in  physics,  in  civics,  and  in  the  fourth- 
year  course  in  hygiene.  There  need  be  no  repetition  that  will 
cause  students  to  "go  stale"  on  the  subject.  In  the  first-year 
hygiene,  emphasis  will  be  placed  upon  the  general  physiolog- 
ical facts  in  regard  to  air  and  health.  This  can  be  scientific 
without  laboratory  or  apparatus.  It  is  only  necessary  that 
cause  and  effect  be  emphasized  constantly.  For  example, 
give  as  a  problem  for  analysis  the  results  in  health  and  mental 
improvement  of  the  open-air  school.  The  report  of  the  re- 
sults of  a  year's  work  in  any  carefully  conducted  open-air 
school  will  provide  the  data.  Then  let  the  students  analyze 
the  conditions  and  state  the  factors  contributing  to  results. 
The  work  will  thus  be  rescued  from  the  doldrums  of  grade- 
school  repetition  and  given  interest  and  vitality.  It  will  be 
scientific  but  will  not  involve  technical  knowledge  of  biology, 
chemistry,  or  physics.  When  the  student  comes  to  the  study 
of  chemistry,  he  will  learn  the  chemical  composition  of  the  air 
and  will  have  experiments  in  air- testing.  In  physics  he  will 
learn  the  significance  of  air  currents,  of  temperature,  humid- 


5oS  EDUCATIONAL  HYGIENE 

ity,  and  perhaps  the  mechanism  of  artificial  ventilation.  In 
biology  there  should  be  study  of  the  relation  of  air  to  the  cells 
of  the  body  and  study  of  the  bacteria  of  the  air.  In  civics 
the  relation  of  pure  air  to  industrial  efficiency,  and  laws  and 
ordinances  relating  to  ventilation  of  schools,  factories,  etc., 
should  be  considered.  In  the  systematic  work  of  the  fourth 
year  there  should  be  co-ordination  and  integration  of  the 
knowledge  of  all  the  pupils.  In  few,  if  any,  high  schools 
would  all  the  fourth- year  pupils  have  studied  all  the  subjects 
specified  above.  This  would  not  be  entirely  a  disadvantage, 
as  it  would  give  opportunity  for  co-operative  work  by  mem- 
bers of  the  class.  For  example,  those  who  had  studied 
chemistry  might  demonstrate  the  chemical  tests  of  air.  The 
result  would  be  mutual  contribution  and  fuller  and  more  vital 
knowledge.^ 

Such  a  plan  of  procedure  would  integrate  health  teaching. 
The  direct  and  collateral  teaching  would  not  be  unrelated  and 
unsystematic,  but  rather  would  be  co-operative  factors  in 
producing  the  desired  result — knowledge  that  is  at  once  scien- 
tific and  practical. 

Content  of  Instruction. — Assuming  that  formal  health  in- 
struction is  to  have  place  in  both  the  first  and  the  fourth 
years,  what  should  be  the  content  of  the  courses  P^  Berry 
suggests  as  the  essentials  "physiology,  bacteriology  (which 
is  essential  to  the  understanding  of  the  nature  of  infectious 
disease),  personal  and  social  hygiene,  sanitation,  and  phys- 
ical education.  .  .  .  Now  is  the  time  to  emphasize  social 
hygiene  and  sanitation.  Let  the  youth  realize  that  in  living 
hygienically  he  is  doing  but  half  his  duty;  the  other  half  is 
to  co-operate  with  others  in  the  struggle  to  transform  an  en- 

'  Davis  recommends  that  hygiene  be  taught  in  the  first  year  as  a  phase  of 
general  science.     (Report  of  the  N.  Y.  School  Inquiry,  Vol.  II.) 

^  If  limited  to  one  year,  the  content  need  not  on  that  account  differ  ma- 
terially from  that  suggested  infra.  If  given  in  the  first  year,  there  would  be  no 
difference,  though  in  schools  where  biology  is  prescribed  in  the  first  year  the 
hygiene  might  be  included  in  the  biology.  If  given  in  the  fourth  year,  the  dif- 
ference would  be  in  extent  rather  than  in  kind. 


HEALTH  TEACHING   IN   HIGH   SCHOOLS  509 

vironment  unfavorable  to  the  health  of  the  community.  .  .  . 
There  are  few  pages  in  modern  history  more  fascinating,  and 
few  illustrate  more  strikingly  the  power  of  knowledge,  than 
those  which  tell  of  man's  desperate  struggle  with  disease.  "^ 

Moseley  would  prescribe  a  course  for  all  students  in  anat- 
omy, physiology,  and  hygiene.  The  character  of  the  course 
given  in  the  first  semester  in  the  Sandusky  High  School  is 
sketched  as  follows:  "The  mere  learning  and  reciting  of 
lessons  from  a  book  may  not  be  useless,  but  it  should  be 
supplemented  by  experiments,  some  of  which  the  pupils  can 
do  at  home  and  report  on  at  school.  A  fresh  heart  and  lungs 
should  be  obtained  from  a  butcher  and  the  lungs  inflated. 
Each  pupil  should  see  the  circulation  in  the  web  of  a  frog's 
foot  or  some  other  animal  membrane.  Models  of  the  eye  and 
several  other  organs  should  be  examined.  The  application  of 
the  lessons  to  actual  living  should  be  discussed  freely  and  the 
difficulties  of  properly  applying  the  knowledge  acquired  should 
be  overcome  if  possible.  The  pupil  while  in  the  secondary 
school  will  not  become  much  of  an  anatomist  or  physiologist, 
but  should  acquire  sufficient  knowledge  of  these  subjects  to 
help  materially  in  understanding  hygiene."  ^ 

He  also  emphasizes  the  conquest  of  disease.  "In  a  town 
in  Africa  I  interviewed  schoolboys,  apparently  about  twelve 
years  old,  who  could  tell  me  about  Louis  Pasteur.  In  this 
country  are  we  to  turn  out  high-school  graduates  who  can 
name  the  wives  of  Henry  VIII  but  who  have  never  heard  of 
Pasteur,  or  Koch,  or  Chittenden?  Are  the  adventures  of 
JEnesLS  at  the  court  of  Dido  more  important  or  more  interest- 
ing than  the  discoveries  of  Reed,  Carroll,  or  Lazear?"  An- 
other urges  that  the  high-school  course  in  hygiene  be  "dif- 
ferentiated to  meet  the  needs  of  pupils  entering  specific  types 
of  vocations."  ' 

^  Ibid.,  p.  358. 

2 Moseley,  "Some  Ways  of  Teaching  Practical  Hygiene,"  School  Science 
and  Mathematics,  vol.  12,  no.  i,  January,  1912. 
'  Towne,  Lillian  H.,  ibid.,  p.  75. 


5IO  EDUCATIONAL   HYGIENE 

These  citations  illustrate  the  tendency  to  emphasize 
social  and  community  hygiene  in  the  high-school  course.  If 
the  pupils  entering  the  high  school  have  been  taught  the 
elements  of  personal  h3'giene  in  the  elementary  schools,  then 
the  first-year  course  in  the  high  school  should  emphasize  the 
social  and  community  phases  of  the  subject.^  The  following 
topics  certainly  should  be  included:  air  and  health,  including 
a  study  of  the  ventilation  of  the  school;  the  public  water 
supply,  its  reason  for  being  and  its  condition;  milk-supply; 
insect  carriers  of  disease;  prevention  and  control  of  infectious 
diseases,  including  immunity;  vital  statistics;  ^  food,  cooking, 
and  pure-food  laws;  industrial  hygiene;  the  work  of  the  health 
departments.  State  and  national  as  well  as  local;  and  a  review 
of  personal  hygiene  with  special  reference  to  matters  of  im- 
mediate significance,  such  as  exercise,  military  drill, ^  recrea- 
tion, sleep,  vision,  elements  of  mental  hygiene,  stimulants  and 
drugs,  and  clothing.  Such  a  content  could  be  given  satis- 
factorily in  a  half-year  course  of  five  periods  a  week;  it  could 
be  given  better  if  integrated  with  the  physical-education  work, 
as  suggested  in  the  following  section,  and  carried  through  the 
first  year. 

The  Drama  of  Preventive  Medicine. — Two  of  the  writers 
quoted  above.  Berry  and  Moseley,  emphasize  what  might  be 
called  the  drama  of  preventive  medicine.  This  is  well.  Here 
is  opportunity  to  appeal  to  the  ancient  fighting  instinct  and 
turn  it  to  account  in  the  conservation,  rather  than  the  de- 
struction, of  human  life.  There  is  the  patient  heroism  of 
research  students  like  Pasteur,  Koch,  and  Chittenden,  com- 
parable to  the  labors  of  military  strategists;  there  is  the  mar- 
tyrdom of  those  like  Carroll,  Lazear,  and  Ricketts  who  have 

'  If  the  work  in  the  grades  has  been  perfunctory,  superficial,  or  desultory, 
then  the  upper-grade  book  of  any  of  the  series  mentioned  above  would  serve 
admirably  as  the  basis  of  the  first-year  high-school  course.  Another  useful 
first-year  book  is  Tolman  and  Guthrie's  "Hygiene  for  the  Worker." 

^  Bibb-Hartmann's  "The  Human  Body  and  Its  Enemies"  has  an  admirable 
chapter  on  this  subject,  entitled,  "Keeping  Account  of  Our  Treasure." 

^  In  schools  that  have  military  drill. 


HEALTH   TEACHING   IN  HIGH   SCHOOLS  511 

sacrificed  life  on  the  firing-line  of  health  science,  correspond- 
ing to  the  martial  heroes  who  have  held  life  cheap  on  many 
a  bloody  field;  and  there  are  the  knights  errant  of  medical 
science  like  Goodhue  of  Molokai,  who  serve  the  outcasts  of 
the  earth  and  at  the  same  time  add  to  the  knowledge  which 
conquers  disease.^ 

A  large  part  of  the  instruction  in  social  and  community 
hygiene  might  radiate  from  this  centre.  The  teaching  easily 
becomes  vital,  scientific,  and  dramatic.  Let  the  starting-point 
be  biography;  let  the  heroism  of  the  sacrifices  and  the  nobility 
of  the  martyrs  shine  forth;  but  let  the  scientific  achievement 
in  each  case  be  clearly  revealed.  Concretely,  suppose  a  class 
of  thirty  pupils.  Let  the  teacher  select  for  study  five  or  six 
of  these  heroic  figures,  each  representing  an  important  sci- 
entific achievement.  Assign  each  to  a  group  of  five  or  six 
students,  give  references,  and  have  reports  covering  in  each 
case:  (i)  a  brief  biography,  (2)  the  special  episode,  (3)  the 
scientific  achievement.  The  class  exercise  will  consist  of 
presentation  and  discussion  of  reports,  the  teacher  correcting, 
clarifying,  and  vitalizing  the  process.  Science  will  acquire 
for  these  students  a  new  dignity,  and  life  a  new  sanctity. 

Systematic  Work  in  Final  Year. — As  suggested  above, 
the  systematic  course  in  the  fourth  year  should  unify  and 
deepen  the  knowledge  of  health  matters  that  may  have  been 
acquired  by  the  students  both  in  their  school  studies  and 
in  their  personal  experience.  This  should  occupy  one  semes- 
ter. Two  plans  are  feasible :  a  rather  narrowly  defined  course 
in  physiology  based  upon  laboratory  experiment;  or  a  topical 

'  The  drama  includes  privates  who  are  rarely  heard  of,  as  well  as  the  laurel- 
crowned  leaders.  After  the  death  of  Doctor  Lazear  in  Cuba  two  private 
soldiers,  John  R.  Kissinger  and  John  J.  Moran,  volunteered  as  subjects  .of  ex- 
periment. Major  Reed  explained  to  them  the  danger  of  the  experiment,  the 
inevitable  suffering  and  possible  death  resulting  from  the  bite  of  the  infected 
mosquitoes;  but  as  they  remained  firm  he  then  offered  them  money  compen- 
sation. Both  declined,  saying  that  they  volunteered  "in  the  interest  of  human- 
ity and  the  cause  of  science."  "In  my  opinion,"  wrote  Major  Reed  afterward, 
"this  exhibition  of  courage  has  never  been  surpassed  in  the  army  of  the  United 
States."     (Coleman,  "The  People's  Health,"  p.  144.) 


512  EDUCATIONAL   HYGIENE 

course,  synthetic  in  character,  utilizing  the  pupils'  knowl- 
edge of  the  basic  sciences,  personal  experiences,  data  of  phys- 
ical training,  and  the  various  health  agencies.  If  the  former 
method  is  followed,  a  well-equipped  laboratory  is  necessary. 
An  adequate  text-book  and  laboratory  manual  are  almost 
equally  necessary.^  If  the  second  method  is  followed,  the 
plan  in  use  in  the  Sandusky  High  School  is  a  suggestive 
model. 2  The  study  of  hygiene  is  carried  on  in  connection  with 
rhetoricals.  "In  the  first  half  of  the  senior  year  the  essays 
all  pertain  to  matters  of  health  and  are  followed  by  comments 
by  the  teacher  and  sometimes  discussion  by  the  pupils."  Sub- 
jects: "Various  diseases,  their  effects,  their  causes,  and  how 
they  may  be  avoided;  the  pupil  choosing  a  subject,  if  pos- 
sible, which  he  knows  about  from  experience."  Other  sub- 
jects are:  "The  most  important  factors  in  the  maintenance  of 
health,  the  most  neglected  factors  in  the  maintenance  of 
health,  erroneous  notions  about  health  and  disease,  length 
of  human  life,  occupation,  exercise,  gymnastics,  rest,  sleep, 
worry,  overwork,  clothing,  bathing,  care  of  the  eyes,  care  of 
the  teeth,  medical  education,  a  doctor's  experiences,  trained 
nurses,  medical  frauds,  patent  medicines,  what  a  city  should 
do  for  the  public  health,  and  quite  a  list  of  subjects  pertain- 
ing to  food  and  drink." 

The  Teacher. — It  is  essential  that  the  health  teaching 
should  be  "conducted  by  a  teacher  who  is  interested  in  it  and 
will  endeavor  to  make  it  of  practical  value.  "^  This  is  logically 
the  teacher  of  physical  education.  The  cultivation  of  health 
habits  and  ideals  is  the  chief  function  of  the  physical  trainer. 
Drills,  setting-up  exercises,  apparatus  work,  dancing,  games, 
athletics,  are  all  worth  while  but  only  as  they  are  instrumental 
in  building  up  positive  health  in  the  pupils  and  quickening  in 
them  a  sense  of  the  dignity  and  the  worth  of  physical  fitness. 

'  Such  as  Eddy's  "Text-book  in  General  Anatomy  and  Physiology  and 
Experimental  Physiology  and  Anatomy"  (American  Book  Co.)  and  Hough  and 
Sedgwick's  "The  Human  Mechanism"  (Ginn  &  Co.). 

2  Moseley,  ibid.,  p.  3.  »  Moseley,  ibid.,  p.  2. 


HEALTH  TEACHING   IN   HIGH   SCHOOLS  513 

The  gymnasium  and  the  playground  are  laboratories  for  the 
study  and  the  application  of  the  principles  of  hygiene.  "The 
teacher  of  physical  training  and  gymnastics  is  the  most 
effective  because  the  most  intimate  teacher  of  personal  hy- 
giene. The  physical  examination  and  the  conduct  of  phys- 
ical exercises  give  occasion  and  opportunity  for  instruction  in 
every  important  aspect  of  hygiene  both  personal  and  general. 
The  harvest  from  this  field  is  rich  for  the  high-minded  and 
adequately  prepared  teacher.'*^  After  all,  effective  teaching 
is  not  that  which  develops  a  subject  but  that  which  touches  the 
individual.  Adequate  physical  examination,  without  which 
physical  training  is  shooting  at  random,  brings  the  teacher 
into  the  closest  and  most  confidential  relations  with  pupils. 
It  enables  the  teacher  not  only  to  prescribe  regimen  for  the 
individual  but  also  to  generalize  the  physical  conditions  and 
needs  of  the  mass  of  pupils.  It  opens  the  way  for  effective 
co-operation  with  parents,  without  which  instruction  is  largely 
void  of  practical  results.  It  is  rational  and  economical, 
therefore,  to  concentrate  in  the  hands  of  the  physical- training 
teacher  both  the  practical  training  in  physical  morals  and  the 
scientific  and  formal  teaching  of  physiology  and  hygiene. 

This  is  in  line  with  the  tendency,  in  the  general  super- 
vision of  health  in  school  systems,  to  concentrate  all  health 
activities  in  one  department.  The  Boston  Department  of 
School  Hygiene,  which  is  the  prototype  of  many  others,  has 
general  control  of  all  matters  affecting  the  physical  welfare 
of  pupils  and  teachers,  except  inspection  for  contagious  dis- 
ease, which  is  under  the  Board  of  Health.  The  director  has 
charge  of  physical  examinations,  nurses,  instruction  in  phys- 
iology and  hygiene,  gymnastics,  athletics,  and  playground  in- 
struction.    Newmayer^  gives  as  the  functions  of  "medical 

» Small,  W.  S.,  "Biologic  Science  and  Health,"  Proceedings  First  Congress 
of  the  American  Association  for  the  Study  and  Prevention  of  Infant  Mor- 
tality, p.  34. 

2  "Medical  and  Sanitary  Inspection  of  Schools,  Philadelphia,"  Lea  &  Febiger, 
1913.  See  also  Rapeer,  "School  Health  Administration,"  Teachers'  College 
Press,  19 13. 


514  EDUCATIONAL  HYGIENE 

inspection":  detection  of  contagious  diseases,  detection  of 
physical  defects,  finding  capacity  of  individual  pupil,  insuring 
hygienic  surroundings,  and  teaching  hygiene  and  healthful 
living.  The  movement  toward  the  centralization  and  co- 
ordination of  all  the  health  factors  in  the  educational  practise 
and  environment  is  very  marked. 

The  concentration  of  all  the  physical-welfare  interests  of 
college  students  in  the  department  of  physical  education  is 
already  an  accomphshed  fact  in  most  colleges.  The  activities 
usually  so  grouped  "include  the  teaching  of  hygiene,  gym- 
nastics, and  athletics,  care  of  students'  health,  and,  in  some 
cases,  the  supervision  of  the  sanitary  conditions  of  school- 
buildings,  dormitories,  kitchens,  water-supply,  and  grounds. 
The  further  development  of  this  growing  tendency  is  limited 
only  by  the  supply  of  competent  men."  ^  In  the  College  of 
the  City  of  New  York  such  co-ordination  has  been  very  com- 
pletely worked  out  under  the  direction  of  the  professor  of 
hygiene  and  physical  education. ^ 

It  might  seem  that  this  plan  would  emphasize  personal 
hygiene  at  the  expense  of  social  hygiene,  but  that  is  far  from 
necessary.  Wherever  students  have  community  interests  and 
practises  there  will  arise  problems  of  community  hygiene. 
"The  sanitation  of  the  exercising  hall,  the  locker- room,  and 
the  swimming-pool  are  emphasized  as  matters  of  community 
importance  and  each  student  is  taught  the  obligation  to  him- 
self and  to  the  community  in  which  he  lives  in  his  relation  to 
his  fellow  students.  In  this  connection  it  may  be  noted  that 
the  swimming-pool  serves  as  a  sort  of  index  to  the  standard 
of  hygiene  maintained  by  the  student  community  using  the 
j)ool.  If  the  bacteriological  analysis  shows  evidences  of  human 
contamination,  the  fact  is  brought  to  the  attention  of  the 

'  Meylan,  "  Report  of  the  Committee  on  Status  of  Instruction  in  Hygiene 
in  American  lukicational  Institutions,"  Proceedings  Fourth  Congress  of 
American  School  Hj-gienc  Association,  iqio,  p.  173. 

-  Storey,  "  Protection  of  Student  Health  in  the  College  of  the  City  of  New 
York,"  Bulletin  No.  46,  U.  S.  Bureau  of  Education,  1913,  "School  Hygiene," 
P-  75- 


HEALTH   TEACHING   IN   HIGH   SCHOOLS  515 

classes  using  the  pool  and  responsibility  is  placed  upon 
them."i 

At  present  the  swimming-pool  is  exceptional  in  the  high- 
school  equipment.  Within  the  next  decade  it  will  be  common 
in  large  new  high  schools.  Where  it  exists,  no  better  means  of 
community  hygiene  instruction  could  be  desired.  The  co- 
operation of  the  biological  department  is  required  for  bac- 
teriological analysis.  Where  there  are  shower-baths,  students 
are  frequently  careless  about  the  use  of  dressing-booths  and 
towels.  A  scarcely  less  impressive  lesson  might  be  based 
upon  bacteriological  analysis  of  towels.  The  active  co-opera- 
tion of  the  student  body  in  promoting  cleanliness  and  general 
community  hygiene  may  be  organized.  This,  indeed,  may  be 
done  independent  of  any  formal  teaching  of  hygiene  by 
physical  trainer  or  any  other  teacher,^  but  would  be  a  natu- 
ral development  of  organized  hygiene  work  in  the  physical- 
training  department. 

Physical  training  should  be  compulsory  through  all  four 
years.  The  logical  plan  would  be  to  have  the  teachers  of 
physical  training  give  the  first-year  course  in  physiology  and 
hygiene,  as  specified  above,  carefully  co-ordinated  with  the 
practical  work  in  physical  education.  The  most  vital  prob- 
lems of  personal  and  community  hygiene  should  be  selected  for 
treatment.  Time  should  be  allowed  for  incidental  instruction 
in  hygiene  throughout  the  course.  To  insure  realization 
in  conduct  of  knowledge  acquired  in  the  first  year,  there  must 
be  the  constant  reinforcement  of  repetition.  Application 
and  implication  must  be  renewed,  emphasized,  amplified. 
It  would  not  be  necessary  or  even  desirable  to  have  a  fixed 
time  for  such  instruction,  but  the  teacher  should  be  alert  for 
occasions  for  such  instruction.  Violations  of  hygienic  recti- 
tude by  members  of  the  class,  illness  or  quarantine  of  a  mem- 

'  Storey,  ihid.,  p.  76. 

2  Hunter,  U.  S.  Bureau  of  Education,  Bulletin  No.  48,  1913,  "School  Hy- 
giene," p.  48.  An  account  of  an  interesting  and  successful  movement  of  this 
nature  in  the  DeWitt  Clinton  High  School. 


5l6  EDUCATIONAL  HYGIENE 

ber,  revelations  of  "unfitness"  in  athletic  meets,  results  of 
physical  examinations,  improvements  made  in  sanitary  con- 
ditions of  the  school,  lunch  habits  of  students,  care  of  lockers, 
ventilation  of  classrooms — these  are  illustrations  of  occasions 
for  halting  physical  exercises  and  having  a  heart-to-heart  talk 
with  (with,  not  merely  to)  a  class  group.  Further,  there  should 
be  the  means  in  the  gymnasium  for  demonstrating  physic- 
logical  and  anatomical  facts  as  occasion  may  arise.  A  mani- 
kin, models  of  important  organs,  charts,  and  lantern  slides 
should  be  essential  parts  of  the  equipment  of  the  physical- 
training  room.  References  should  be  easily  available  so  that 
important  topics  may  be  studied  further  and  reported  upon. 
Conclusion. — Two  objections  may  be  made  to  this  plan  of 
procedure — one,  that  as  yet  comparatively  few  high  schools 
have  a  teacher  of  physical  training;  the  other,  that  com- 
paratively few  teachers  of  physical  training  possess  the  scien- 
tific training  in  biology,  physiology,  and  hygiene  requisite  for 
the  successful  conduct  of  the  health  teaching  as  outlined. 
These  objections  lie  not  against  the  plan  itself  but  only  against 
its  present  feasibility.  It  is  true  that  few  schools  have  a 
teacher  of  physical  training — 8  per  cent  according  to  Gulick's 
investigation,  cited  above — but  it  is  equally  true  that  few 
schools  include  health  teaching  in  their  courses  of  study. 
Recognition  of  the  unitary  character  of  these  two  factors  in 
health  education  will  give  both  impetus  and  direction  to  the 
movement  for  definite  and  systematic  teaching  of  the  sub- 
ject. The  other  objection  is  no  more  substantial.  It  is  prob- 
ably true  that  many,  if  not  a  majority,  of  the  present  high 
school  teachers  of  physical  training  are  disciples  of  some 
"school"  of  gymnastics.  Comparatively  few  have  been 
broadly  trained  in  the  sciences  that  are  fundamental  to  the 
understanding  of  hygiene.  They  are  teachers  of  gymnastics, 
not  of  hygiene.  This  condition,  however,  is  improving.  Uni- 
versities, colleges,  normal  schools,  and  the  special  schools  of 
physical  training  are  gradually  establishing  physical  educa- 
tion on  the  right  basis.     An  insistent  demand  for  teachers 


HEALTH  TEACHING  IN  HIGH   SCHOOLS  517 

of  physical  education,  adequately  trained  according  to  the 
standards  indicated  in  this  chapter,  will  tend  to  hasten  the 
supply.  In  the  meantime,  the  instant  need  must  be  met  in 
the  practical  way  suggested  at  the  beginning  of  this  section, 
by  placing  the  health  instruction  in  the  hands  of  a  teacher, 
regardless  of  his  major  subject,  who  is  interested  in  the  matter 
and  will  grow  up  with  the  work. 


CHAPTER  XXVII 

PROFESSIONAL  TRAINING   OF   SCHOOL-HEALTH 
WORKERS 

Teachers,  Nurses,  Physicians,  Physical-Educationists, 
AND  Hygiene  Supervisors 

The  Demand  of  Public  Opinion. — The  recent  arousal  of 
the  American  people  to  a  fair  sense  of  the  importance  of  the 
values  of  health,  vigor,  bodily  resistance,  conservation  of 
vitality,  and  normal  physical  development  is  without  parallel 
since  the  days  of  ancient  Greece.  The  playground  move- 
ment, the  tuberculosis  movement,  the  medical-inspection 
movement,  the  anti-fly,  the  anti-common-cup  and  common- 
towel  movements,  the  open-air-school  movement — these  and 
a  great  many  more  health  developments  have  moved  over 
this  country  in  the  last  few  years  hke  fire  in  dry  prairie  grass. ^ 
Were  we  able  to  plot  for  all  these  movements  a  composite 
curve  of  growth,  we  should  undoubtedly  be  able  to  demon- 
strate what  Gulick  and  Ayres  in  1910  showed  for  medical 
inspection,  that  at  the  rate  of  increase  now  going  on  most 
cities  and  villages,  at  least,  will  in  a  few  years  be  supplied  with 
most  modern  school-health  provisions.  The  school-health 
movement  could  hardly  be  said  to  have  begun  before  1904 
or  1906,  and  is  therefore  little  over  eight  or  ten  years  old, 
about  the  age  of  a  child  when  he  enters  his  first  serious  "  tran- 
sitional" stage  of  development. 

This  has  been  the  public  demand,  and  it  has  caused  the 
movement  to  grow  with  such  rapidity  that  its  transitional 
stage  now  imminent  bids  fair  to  be  as  serious  as  that  of 
children  when  they  lose  their  temporary  teeth,  become 
weak  and  flabby,  and  suffer  a  high  morbidity.     According  to 

'  See  the  heallh  and  mortality  symposium  in  the  Popular  Science  Monthly 
for  April,  1915. 

S18 


TRAINING   OF    SCHOOL-HEALTH   WORKERS  519 

a  rule  of  our  democracy,  of  which  Lowell  long  ago  spoke,  we 
Americans  have  a  hip-hip-hurrah  manner  of  quickly  taking 
up  new  movements;  hiring  some  persons,  chosen  almost  at 
random  from  our  midst,  to  start  the  picked-up  machinery; 
and  then,  thinking  we  have  done  our  entire  democratic  and 
patriotic  duty,  have  either  rushed  off  after  some  other  new 
idea  or  have  complacently  gone  home,  never  after  giving  a 
thought  to  the  new  agency  we  have  called  into  being  until 
it  breaks  down  from  sheer  inefficiency  and  lack  of  public  sup- 
port, thus  reminding  us  of  our  former  dreams  of  automatic 
governmental  achievement. 

We  have,  then,  according  to  this  method,  many  new  phases 
of  health  work  and  multitudes  of  new  health  responsibilities 
thrust  upon  the  schools.  The  administrative  machinery  is 
poor  or  absent  altogether;  the  nurses  are  "visiting"  or  other 
nurses  picked  up  almost  at  random,  or  even  substitute  teachers 
of  the  schools;  the  doctors  are  commonly  part-time  physi- 
cians of  the  kind  so  ably  and  so  mercilessly  described  by 
Flexner  in  his  searching  investigation  of  American  medical 
schools;  the  teachers  are  supposed  to  inspect  their  children 
medically  and  send  down  the  ailing  ones  to  doctor  or  nurse, 
when  they  have  for  the  task  neither  medical  nor  hygienic 
training  or  interest;  the  physical-educationists  face  their  en- 
larged duties  with  still  less  training  if  possible,  even  though 
they  have  been  supposed  to  be  the  special  guardians  of  the 
physical  welfare  of  the  children.  Moreover,  all  these  people 
are  miserably  paid  for  their  work;  there  seems  to  be  httle 
evidence  of  much  increase  of  attention  to  their  education  to 
meet  their  larger  responsibilities;  and  if  this  new  health  in- 
strument and  agency,  like  so  many  before,  does  not  actually 
break  down  from  a  lack  of  the  necessary  democratic  "follow- 
up"  method,  the  school-health  movement  is,  in  this  predica- 
ment, doomed  to  only  very  limited  and  half-hearted  success. 
The  problem  of  the  strengthening  of  the  movement  by  the 
fundamental  method  of  strengthening  its  agents  is  the  problem 
of  this  chapter. 


520  EDUCATIONAL  HYGIENE 

Limitations  in  Meeting  the  Demand. — In  meeting  the 
demand  of  pubHc  opinion  and  public  sentiment,  however, 
there  are  decidedly  discouraging  limitations.  It  is  all  very 
well  to  describe  in  a  general  way  what  the  talented  and  well- 
trained  professional  teacher  should  or  may  do  in  meeting  the 
health  and  developmental  needs  of  her  children,  her  school 
environment,  and  her  community.  But  when  we  remember 
that  few  teachers,  comparatively,  are  talented,  well  trained, 
or  professional;  that  few  have  an  education  at  a  normal  school 
where  there  is  a  yet  unrealized  possibility  of  getting  some 
knowledge  of  educational  hygiene;  that  half  of  the  teachers  of 
this  country,  according  to  Coffman  and  other  investigators, 
have  not  even  a  high-school  education;  that  for  all  teachers 
in  elementary  and  high  schools  the  average  period  of  service  in 
teaching  is  only  four  years;  and  that  the  large  majority  of 
these  uneducated  teachers  are  young  girl  novices  without  ex- 
perience and  without  any  very  professional  interests  or  abil- 
ities, then  we  see  some  of  the  peculiar  and  serious  limitations 
set  upon  the  school-health  movement.  There  is  little  need 
of  idealizing  over  what  the  schools  will  in  a  few  years  do  for 
the  health  of  this  country,  when  we  are  confronted  by  a 
situation  like  this  with  respect  to  the  fundamental  school- 
health  agent,  the  teacher.  What  is  said  of  teachers  will  also 
apply  in  general  to  the  other  more  or  less  specialized  health 
workers. 

The  best  plans  we  have  yet  had  made  for  the  development 
of  school-health  work  in  this  country  agree  pretty  well  in  the 
demand  for  one  nurse  and  one  part-time  physician  for  each 
two  to  three  thousand  pupils  in  the  public  schools.  Taking 
twenty-five  hundred  instead  of  these  numbers  as  the  standard 
and  dividing  this  into  twenty  million,  the  number  of  school- 
children, we  see  that  the  tendency  is  strongly  in  the  direction 
of  the  appointment  of  some  eight  thousand  doctors  and 
eight  thousand  nurses  for  public-school  work,  not  counting 
medical  supervisors,  nor  physicians  and  dentists  in  clinics. 
Of  teachers  we  have  a  half  million,  one-fourth  of  whom  are 


TRAINING   OF   SCHOOL-HEALTH   WORKERS  52 1 

dropping  out  of  teaching  each  year,  while  normal  and  other 
professional- training  schools  furnish  only  about  twenty  thou- 
sand— -less  than  a  sixth  of  the  annual  number  needed.  When 
it  comes  to  psychologists  for  pubHc-school  psychological  clinics 
we  are  little  better  off. 

How  to  Meet  the  Problem. — Evidently  we  shall  be  com- 
pelled under  existing  conditions  to  depend  on  many  more 
mechanical  and  routine  factors  than  the  health  training  of 
teachers  before  or  after  they  enter  the  profession.  Among 
some  of  these  factors  that  now  present  themselves  as  being 
most  practical  are  the  following: 

(i)  The  appointment  of  investigating  committees  to  study 
and  to  recommend  definite  standards  for  as  many  phases  of 
school  hygiene  as  possible. 

(2)  The  establishment  of  departments  of  educational  hy- 
giene in  State  and  local  departments  of  education  with  men 
at  their  heads  who  are  first-class  speciaHsts  in  this  field,  and 
who  are  given  a  good  deal  of  power  and  financial  resources 
to  enable  them  to  put  into  the  hands  of  the  teachers,  nurses, 
doctors,  school  boards,  and  others  the  school-health  stand- 
ards developed  by  the  specialists,  and  which  they  can  more 
or  less  mechanically  follow.  Such  reasonable  standards  as 
jacketed  stoves  for  rural  schools,  lighting  space  which  is  equal 
in  area  to  one-fifth  or  more  of  the  floor  space,  and  the  20/40 
dividing  line  for  defective  vision  with  Snellen's  test-charts  used 
as  directed — all  such  standards  can  be  enforced  by  expert 
State  and  local  authorities  with  considerable  improvement  in 
school-health  conditions.  Often  the  reason  communities  and 
school  workers  do  not  get  health  results  is  because  they  do 
not  know  reasonable  health  standards.  They  do  not  know, 
for  example,  how  much  light  a  school  should  have  or  how  ap- 
proximately to  measure  it.  When  they  are  told  the  standard, 
they  may  be  enticed  or  made  to  act  in  accordance  therewith. 

(3)  State  and  local  surveys,  such  as  the  recent  Ohio, 
Pennsylvania,  Illinois,  and  Vermont  surveys,  which  will  show 
up  the  health  needs,  as  measured  by  certain  standards  given 
wide  publicity. 


522  EDUCATIONAL  HYGIENE 

(4)  The  establishment  of  departments  oj  school  co-operation 
in  State  and  local  departments  of  education,  where  skilled 
public-opinion  and  public-sentiment  developers  may  help  all 
lay  and  professional  organizations  of  the  State  to  put  their 
shoulders  to  the  wheels  of  school-health  progress,  thus  fur- 
nishing the  schools  both  with  public-opinion  pressure  and 
public-opinion  support  for  progressive  health  measures.  Such 
a  department  has  recently  been  established  in  the  reorganized 
State  Department  of  Education  of  Ohio. 

(5)  The  school-health  training  of  teachers,  nurses,  doctors, 
and  others  while  in  service. 

(6)  The  education  of  prospective  school-health  workers  in 
the  science  and  practise  of  educational  hygiene,  in  high  schools, 
normal  schools,  medical  schools,  and  elsewhere. 

The  Health  Education  of  Teachers. — For  the  sixth  or 
seventh  of  the  teaching  force  of  the  country  that  receive  some 
professional  preparation  at  normal  and  other  professional 
schools  a  vast  improvement  in  health  education  is  necessary 
and  easily  possible.  If  the  work  in  personal  and  public  hy- 
giene, physical  education,  medical  supervision,  etc.,  were 
well  done  in  the  elementary  and  secondary  schools,  the  re- 
sponsibilities of  professional  institutions  would  not  be  so 
great.  But  this  foundation  work  is  very  deficient,  as  all 
studies  and  surveys  show.  Several  studies  show  how  the  pro- 
fessional institutions  are  meeting  the  problem.  While  most 
training  institutions  have  required  courses  in  educational 
psychology,  educational  history,  educational  methods,  and 
even  educational  administration  and  educational  sociology, 
yet  very  few  if  any  have  satisfactory  courses  in  educational 
hygiene. 

Several  studies  show  how  pedagogical  training  schools  are 
meeting  the  problem.  We  may  refer  to  but  one  or  two. 
Terman,  in  his  volume  on  "The  Teacher's  Health,"  briefly 
summarizes  Heche's  investigation  by  questionnaire  of  "The 
Teaching  and  Practise  of  Hygiene  in  the  Public  Normal 
Schools  of  the  United  States,"  returns  from  eighty-four  of 
the  better  class  of  schools  being  used  and  showing: 


TRAINING   OF   SCHOOL-HEALTH   WORKERS  523 

(i)  That  one-half  of  the  eighty-four  schools  offer  either  no  hygiene 
at  all,  or  else  none  aside  from  that  given  incidentally  in  connection 
with  physiology.  Nine  schools  give  neither  hygiene  nor  physiology, 
and  those  giving  the  latter  devote  so  little  time  to  it  (usually  one- 
third  or  one-half  of  a  year)  that  very  little  can  be  accomplished  in 
hygiene. 

(2)  That  courses  in  personal  hygiene,  school  hygiene,  sanitation, 
prophylaxis,  clinical  psychology,  etc.,  are  only  slowly  finding  a  place 
in  the  normal-school  course  of  study,  and  that  mental  hygiene  is  re- 
ceiving scarcely  any  attention. 

(3)  That  comparatively  little  is  being  done  with  the  problem  of  sex 
hygiene  in  the  way  of  direct  instruction,  and  that  the  normal  schools 
are  not  making  the  best  of  their  opportunity  to  train  teachers  who 
can  use  nature  study  and  biology  as  an  approach  to  the  subject. 

(4)  That  in  the  practise  of  hygiene  nearly  two-thirds  of  the  schools 
confess  themselves  guilty  of  harboring  conditions  that  should  not  be 
allowed  to  exist,  chiefly  inadequate  ventilation,  improper  lighting, 
unsatisfactory  boarding  and  rooming  places,  and  overpressure. 

(5)  That  25  per  cent  of  the  schools  do  not  have  a  gymnasium  in 
the  charge  of  a  physical  director  and  that  athletics  and  recreation  do 
not  receive  the  attention  they  should. 

(6)  That  but  few  of  our  normal  schools  are  giving  special  training 
to  teachers  in  the  observation  of  physical  defectiveness  or  in  the  ap- 
plication of  mental  and  physical  tests. 

(7)  That  only  one  of  the  eighty-four  schools  attempts  to  train 
special  teachers  of  hygiene  for  the  public  schools. 

(8)  That,  on  the  whole,  sufficient  science  is  offered  (though  not 
necessarily  required)  to  serve  as  a  reasonably  good  foundation  for  the 
various  forms  of  hygiene  instruction,  and  that  a  good  proportion  of 
the  teachers  of  physiology  and  hygiene  in  these  schools  have  uni- 
versity or  college  degrees  and  are  probably  capable  of  doing  better 
work  than  their  present  allotment  of  time  permits. 

In  the  light  of  the  modern  advances  in  preventive  medicine,  to- 
gether with  the  wide-spread  interest  in  the  social  aspects  of  hygiene 
and  the  recognition  of  the  importance  of  athletics,  play,  and  the  phys- 
ical side  generally  in  the  scheme  of  education,  the  present  compara- 
tive neglect  of  educational  hygiene  in  the  normal  schools  becomes  an 
intolerable  anachronism. 

These  conclusions  are  verified  from  many  different  angles, 
such,  for  example,  as  the  inability  of  teachers  to  care  for  their 
own  health.  And  if  these  chosen  few  who  go  into  the  schools 
with   professional   training    are   so    deficient   on    the   whole 


524  EDUCATIONAL  HYGIENE 

physical  side  of  development,  then,  hygienically  speaking, 
we  have  in  the  schools  little  more  than  the  blind  leading 
the  blind. 

Every  teacher  should  learn  before  she  is  ready  to  enter  the 
normal  school  or  the  schoolroom  the  principal  facts  of  personal 
and  public  hygiene.  If  she  lives  in  the  country  and  is  to 
teach  in  the  country,  then  her  study  of  public  hygiene  should 
be  principally  that  of  rural  hygiene  closely  related  to  the 
serious  health,  medical,  recreational,  and  sanitary  problems 
of  rural  life.  If  in  the  city,  she  should  "know  her  city"  from 
the  health  standpoint.  This  teaching  must  be  done  in  ele- 
xnentary  and  high  schools.  Then,  with  some  study  of  biology, 
chemistry,  domestic  science,  and  elementary  sociology,  rural 
or  urban,  she  should  go  forward  into  the  field  of  educational 
hygiene,  not  to  master  the  whole  science  but  such  facts  as 
are  most  essential  for  our  teachers  in  their  schools  and  class- 
rooms to  know. 

This  will  mean  that  she  will  learn  not  only  the  mental 
nature  of  children  but  she  will  learn  to  understand  and  recog- 
nize mental  and  physical  abnormalities  with  reference  to 
certain  norms  or  standards.  She  will  learn  to  look  upon  chil- 
dren not  as  mere  disembodied  mentalities  but  as  physical 
beings  as  well.  To  a  large  extent,  with  a  little  study  and 
practise,  each  intelligent  young  teacher  can  learn  in  her  pro- 
fessional training  course  how  to  inspect  medically  and  test 
her  pupils.  Doctor  Hoag  says  a  good  teacher  can  easily 
learn  to  pick  out  80  per  cent  of  the  ailments  and  defects  of 
children  and  will  miss  very  few  serious  cases.  If  she  has  the 
jight  kind  of  ability,  too,  and  learns  how  to  meet  parents  and 
utilize  other  curative  agencies,  she  can  get  most  ailments  and 
defects  cared  for.  Of  course,  she  should  be  relieved  by  a 
good  nurse,  but  even  where  there  are  nurses  the  responsibility 
of  teachers  is  great  and  growing  in  this  direction.  The  normal 
school  should  have  clinics  for  elementary  diagnosis,  where  a 
number  of  children  are  brought  in  before  the  classes  and  the 
symptoms  of  the  important  ailments  and  deficiencies  pointed 


TRAINING   OF   SCHOOL-HEALTH   WORKERS  525 

out  by  a  competent  person.  It  will  not  be  long  before  actual 
and  prospective  teachers  will  have  for  their  daily  use  con- 
venient and  practical  handbooks  of  school  health  which  in 
the  simplest  and  most  convenient  form  will  place  before  them, 
not  a  great  cumbrous  science  filled  with  engineering,  medical, 
and  administrative  problems  which  will  never  confront  a 
teacher,  but  the  main  facts  regarding  the  health  of  herself  and 
children,  of  the  sanitation  of  her  own  and  the  pupils'  environ- 
ment, the  teaching  of  modern  hygiene,  physical  education,  and 
the  hygiene  of  instruction,  over  which  she  and  the  pupils  and 
parents  have  some  immediate  control  and  responsibility. 

Along  with  this  study  should  be  furnished  simple  symptom 
charts^  showing  teachers  how  to  read  each  child's  "health 
index";  simple  statements  of  reasonable  standards  for  the 
health  and  physical  development  of  children;  simple  forms  for 
surveying  the  sanitary  condition  of  the  schoolhouse,  the 
school-yards  and  their  equipment,  with  clear  statement  of 
reasonable  standards  to  work  for ;  simple  statements  of  how  to 
promote  the  physical  development  of  children,  with  reason- 
able standards  of  physical  proficiency  to  be  striven  for  at 
various  ages  for  different  groups;  simple  statements  of  the 
subject-matter,  methods,  and  texts  that  will  bring  about 
most  readily  the  best  health  knowledge,  health  ideals,  and 
health  habits  for  pupils  and  community;  and,  finally,  simple 
statements  of  how  to  teach  in  such  a  way  as  to  make  the  very 
life  of  the  school  and  the  methods  and  atmosphere  of  its  work 
contribute  to  health,  well-being,  and  happiness  instead  of 
nervousness,  overpressure,  antagonism,  routinism,  and  dis- 
piriting inefl&ciency. 

For  those  teachers  who  have  not  had  the  advantage  of  pro- 
fessional training — the  large  majority — we  must  resort  to  a 
variety  of  methods  besides  those  mentioned,  such  as  furnish- 
ing them  health  handbooks  and  forms,  and  insuring  them  good 
hygienic  training  in  their  elementary  and  high-school  courses. 
They  must  have  a  large  amount  of  skilled  health  supervision 

»See  page  215. 


526  EDUCATIONAL   HYGIENE 

according  to  some  such  administrative  plan  as  that  suggested 
in  earlier  chapters;  their  communities  must  be  set  buzzing 
about  their  ears  demanding  superior  school-health  provisions, 
as  suggested  in  chapters  on  pubUc  co-operation;  teachers' 
institutes,  teachers'  meetings  and  associations,  reading  cir- 
cles, lectures,  traveUing  moving  pictures,  models  of  sanitary 
schoolhouses  and  equipment  to  be  sent  to  districts  requesting 
them,  bulletins  from  the  State  and  Federal  bureaus  of  educa- 
tion, the  assistance  of  doctors  and  nurses,  parents'  associations, 
health  days  in  the  schools,  budget  exhibits,  the  co-operation 
of  school-children  for  school-health  work  along  the  lines  of 
self-government,  student  investigations  of  school  and  com- 
munity sanitary  conditions — these  and  a  great  many  more 
methods  can  be  utilized  to  improve  the  health  conditions  of 
schools  in  spite  of  the  limitations  of  poor,  inexperienced, 
transient  teachers. 

The  Training  of  Nurses.^ — Next  to  the  teacher  the  most 
important  health  agent  in  the  average  community  will  be  the 
well-trained  or  the  adaptable  school  nurse.  Unfortunately, 
the  education  of  nurses  is  about  as  poorly  provided  for  as  is 
that  of  teachers,  and  is  claiming  a  great  deal  of  attention  on 
the  part  of  those  interested  in  school-health  advance.  The 
school  nurse  is  the  most  important  special  health  agent  the 
school  is  to  acquire  in  this  movement,  and  upon  her  skill  and 
breadth  of  training  depends  very  greatly  the  extent  of  the 
school's  service  to  the  public. 

She  must  hereafter  be  regarded  as  an  integral  part  of  our 
educational  system.  That  system  has  through  long  years  of 
development  been  brought  to  a  high  state  of  organization. 
Pupils  have  been  graded,  subjects  have  been  elaborately  de- 
lined  for  every  grade,  teachers  have  been  provided  for  every 
subject,  a  body  of  officers  of  varying  rank  and  degree  have 
been  installed. 

iThe  editor  has  received  the  skilled  assistance  of  Ella  Phillips  Crandall, 
R.N.,  Executive  Secretary  of  the  National  Organization  for  Public  Health 
Nursing,  in  the  preparation  of  this  section,  most  of  it  being  her  work. 


TRAINING   OF    SCHOOL-HEALTH   WORKERS  527 

In  like  manner  an  appropriate  system  of  training  has  been 
elaborated  for  each  member  of  the  teaching  and  official  body 
wherewith  to  give  him  suitable  command  of  the  subjects  he 
teaches  and  the  duties  he  performs.  We  have  gone  still 
farther.  Laws  have  been  procured  requiring  that  persons 
desiring  to  teach  shall  equip  themselves  in  certain  well-de- 
fined ways,  and  shall  pass  certain  prescribed  examinations,  and 
shall  receive  certificates  testifying  to  their  adequate  prepara- 
tion to  do  the  work  required. 

In  like  manner  and  in  the  same  degree  is  it  necessary  that 
we  should  require  for  a  branch  of  school  work  so  vitally  im- 
portant as  the  health  of  the  children,  workers  who  have  been 
carefully  and  adequately  prepared  for  the  work  which  they 
have  to  do  and  whose  training  has  been  directed  toward  a 
definite  and  special  end. 

But  how  have  we  carried  out  these  principles  in  this  new 
and  important  addition  to  our  public-school  forces?  What 
are  the  present  requirements,  so  far  as  any  exist,  for  the  prep- 
aration of  school  nurses? 

Whether  medical  inspection  is  conducted  under  depart- 
ments of  education  or  departments  of  health,  the  usual  quali- 
fication for  appointment  of  the  school  nurse  is  that  the  candi- 
date for  the  nursing  service  shall  have  had  the  training  of  a 
nurse.  In  most  instances  this  is  the  highest  if  not  the  only 
requirement.  In  a  few  places  additional  qualifications  are 
that  the  candidate  shall  be  a  registered  nurse  and  shall  have 
passed  civil-service  examinations.  However,  even  the  funda- 
mental requirement  that  the  candidate  shall  be  a  graduate 
nurse,  having  received  the  full  ordinary  training  of  a  nurse, 
is  not  always  required.  There  have  been  numerous  instances 
in  which  personal  friendships  or  political  interests  have  con- 
trolled their  appointments,  to  the  obliteration  of  all  suitable 
standards  of  training  and  general  education. 

What  Graduate  or  Trained  Nurse  Means. — The  present 
general  requirement,  then,  is  graduation  from  a  training  school 
for    nurses,   and   it  is   necessary,   therefore,   to   understand 


528  EDUCATIONAL   HYGIENE 

clearly  what,  in  the  present  state  of  nursing  education,  this 
means.  To  set  forth  fully  the  present  status  of  training 
schools  for  nurses  would  require  more  time  than  is  allotted  to 
this  paper.  We  can  only  point  out  very  briefly  a  few  perti- 
nent facts  and  some  of  their  causes. 

Practically  all  training  schools  are  under  the  control  of 
the  hospital  management  to  which  they  are  attached.  All 
are  created  primarily  for  the  purpose  of  serving  the  hospital 
rather  than  of  educating  nurses.  The  hospitals  themselves 
vary  in  size  from  ten  to  one  thousand  beds,  and  their  range  of 
service  is  as  varied  as  their  capacity.  Some  are  intended  and 
equipped  for  the  treatment  of  one  kind  of  disease  only,  others 
for  general  service.  Because  of  these  facts,  the  clinical  op- 
portunities afforded  by  these  institutions  and  the  attitude  of 
their  boards  toward  the  importance  of  the  nurse's  education 
determine  both  the  character  and  extent  of  her  training 
rather  than  any  suitable,  recognized,  and  accepted  standard. 
Therefore  the  term  "graduate"  or  "trained"  nurse  is  at  pres- 
ent capable  of  many  interpretations  and  is  no  guarantee  what- 
ever of  even  a  sound  general  training  in  nursing. 

Nothing  more  clearly  demonstrates  this  fact  than  the 
existence  of  the  numerous  short-term  and  correspondence 
schools.  For  instance,  the  Chautauqua  Correspondence 
School  alone  graduated  during  the  past  ten  years  approxi- 
mately twelve  thousand  students  as  compared  with  approxi- 
mately eight  thousand  from  all  the  registered  schools  of  New 
York  State. 

Among  other  efforts  to  improve  these  conditions,  attempts 
have  been  made  in  thirty-five  States  to  establish  standards 
of  training  for  nurses  by  statute  and  by  the  use  of  the  term 
"registered  nurse"  applied  to  those  whose  training  has  covered 
certain  prescribed  ground  and  who  have  passed  certain  re- 
quired tests  and  examinations.  In  States  where  such  laws 
obtain,  the  basic  qualification  for  a  school  nurse  should  be  not 
a  "graduate  nurse"  only  but  a  "registered  nurse."  This 
not  only  upholds  and  strengthens  efforts  to  maintain  educa- 


TRAINING   OF    SCHOOL-HEALTH   WORKERS  529 

tional  standards,  but  also  affords  the  only  guarantee  at  present 
existing  that  the  candidate  has  received  even  a  minimum  of 
suitable  training  and  experience. 

Qualifications  of  a  School  Nurse. — But  even  this  com- 
paratively recent  and  by  no  means  general  requirement  does 
not  express  the  measure  of  preparation  necessary  for  the 
school  nurse  or  for  any  other  worker  in  the  various  fields  of 
public-health  nursing.  The  nurse  should  stand  educationally 
on  a  level  with  the  teaching  staff.  Her  qualifications  should 
go  back  of  and  beyond  that  of  registration.  It  should  be  in- 
sisted upon  that  her  preliminary  education  shall  be  at  least  a 
high-school  graduation  or  its  equivalent.  At  present  the  stat- 
utory requirement  in  some  States  is  one  year  of  high  school, 
and  nurses  are  holding  even  that  standard  with  difficulty, 
owing  to  pressure  from  institutions  determined  to  lower 
educational  requirements  for  admission. 

At  present,  therefore,  it  is  obviously  necessary  to  select 
carefully  even  among  registered  nurses  to  secure  those  who 
have  had  suitable  general  education,  and  yet  there  should  not 
be  placed  upon  the  staff  of  the  public  schools  in  the  capacity 
of  school  nurses  women  of  much  lower  educational  attainments 
than  would  be  appointed  to  any  other  office  in  the  schools, 
either  as  teachers  or  supervisors. 

As  a  fair  proportion  of  women  graduating  from  our  nurses' 
training  schools  have  had  full  high-school  work  or  normal 
training,  while  several  have  college  degrees,  or  a  partial  college 
course,  it  will  be  possible  ultimately  to  secure  women  of  such 
education  when  once  the  requirement  is  made.  Such  a  re- 
quirement will  be  of  great  help  to  nurses'  training  schools, 
lending  support  and  strength  to  their  efforts  to  maintain  suit- 
able educational  admission  standards= 

But  we  must  go  farther.  The  public-school  nurse  needs  a 
very  considerable  amount  of  special  training  not  at  present 
provided  in  any  school  of  nursing.  It  is  to  be  hoped  that  the 
day  may  not  be  far  distant  when  our  training  schools  may  be 
free  to  so  enlarge  and  extend  their  curricula  as  to  provide 


530  EDUCATIONAL   HYGIExNE 

several  courses  of  education  for  their  students,  each  leading 
to  its  own  diploma,  and  that  this  may  be  done  without 
hazard  to  the  present  standards  of  work  in  our  institutions, 
w^hich  in  a  great  many  instances  are  even  now  pathetically 
meagre.  Until  then  the  special  training  needed  must  be 
sought  and  found  in  postgraduate  study. 

Training  with  Children. — The  work  of  the  school  nurse, 
though  dealing  with  all  classes  and  ages  of  people,  is  primarily 
among  children.  Some  hospitals  afford  no  opportunity  what- 
ever for  training  in  this  branch  of  work,  and  no  general  hos- 
pital, as  a  rule,  gives  enough  to  prepare  a  nurse  properly  for 
school  work. 

The  school  nurse  needs  a  very  special  and  practical  train- 
ing in  the  observation,  study,  and  care  of  children.  She  should 
be  quite  familiar  with  the  ordinary  diseases  of  children.  She 
should  be  especially  so  with  all  the  commoner  infectious  dis- 
eases of  childhood  and  with  their  early  symptoms.  Nothing 
short  of  several  months  in  a  children's  ward  or  hospital  can  pro- 
vide a  nurse  with  that  first-hand  knowledge  and  experience 
which  her  work  among  children  calls  for. 

In  addition  to  this,  there  should  be  some  further  study  in 
a  dispensary  or  clinic  in  the  following  special  subjects:  dis- 
eases of  the  eye,  ear,  nose,  throat,  and  infectious  and  skin 
diseases.  The  quick  recognition  of  any  departure  from  the 
normal  in  all  of  these  should  be  expected  of  the  school  nurse. 
She  must,  in  other  words,  diagnose  that  something  needs  to  he 
diagnosed.  This  means  only  that  the  nurse  exercises  the 
function  which  every  mother  exercises  whenever  she  sends  for 
the  doctor,  except  that  the  nurse  acts  upon  the  intelligent 
judgment  which  comes  from  more  expert  knowledge. 

Her  work  is  by  no  means  limited  to  the  school.  It  ex- 
tends to  the  home — a  highly  important  part;  indeed,  by  some 
considered  the  most  important — where,  for  such  reasons  as 
the  exclusion  of  the  child  from  school  because  of  some  infec- 
tious condition  or  for  other  causes  equally  urgent,  the  mother 
needs  advice  and  instruction.     Many  questions  arise  in  the 


TRAINING  OF   SCHOOL-HEALTH  WORKERS  53 1 

course  of  the  nurse's  home  visiting  which  do  not  bear  di- 
rectly upon  the  child's  physical  condition  or  care,  yet  do  in- 
directly affect  it  and  therefore  must  be  not  only  recognized  and 
understood  by  the  nurse  but  handled  intelligently. 

Education  in  Health  Sociology. — It  is  here  that  school 
nurses  have  failed  often  and  seriously  for  lack  of  adequate 
preparation  for  their  work,  and  in  consequence  have  been 
subjected  to  severe  criticism  from  their  social-worker  col- 
leagues. It  cannot  be  urged  too  strongly  that,  because  of  the 
nurse's  unique  opportunity  (due  directly  to  her  intimate  re- 
lation in  the  homes  which  she  enters)  to  render  a  many-sided 
service,  she  should  be  so  trained  as  to  qualify  her  to  meet  and 
handle  effectively  the  varied  demands  that  are  made  upon  her. 
These  may  be  any  of  the  problems  which  arise  in  the  indus- 
trial family.  They  range  from  improper  home  conditions 
and  parental  neglect,  owing  to  ignorance  or  bad  habits,  to 
bad  housing  or  other  conditions  due  to  private  or  municipal 
neglect,  or  they  may  be  those  of  extreme  poverty. 

To  deal  with  these  intelligently  requires  a  special  training 
in  the  treatment  of  social  and  municipal  problems.  This 
training  should  include  something  of  housing  laws,  of  domestic 
and  municipal  sanitation,  and  of  such  local  regulations  relating 
to  them  as  will  enable  the  nurse  to  lay  hold  promptly  and  with 
assurance  upon  all  public  agencies. 

In  like  manner  the  nurse  must  be  equipped  to  meet  the 
almost  constant  demands  for  relief,  for  it  takes  a  special  train- 
ing to  know  how  to  give  this  so  that  it  will  not  prove  to  be  a 
positive  injury.  The  right  persons  or  agencies  must  be  sought 
for  the  treatment  of  such  problems  as  cannot  be  handled  ap- 
propriately by  the  nurse.  She  will  be  the  one  to  discover 
the  problem;  she  will  not  always  be  the  right  one  to  deal  best 
with  it,  but  in  either  instance  the  nurse  is  called  upon  to  render 
a  social  diagnosis  for  which  the  treatment  may  involve  serious 
and  lasting  consequences  to  the  family. 

Home  Hygiene. — To  teach  the  mother  how  to  feed  her 
children  becomes  one  of  the  nurse's  most  frequent  duties. 


532  EDUCATIONAL  HYGIENE 

To  do  this  requires  a  special  training  in  nutrition  and  in 
dietaries  for  children  of  different  ages,  whereas  in  her  training 
school  the  nurse  has  learned  only  foods  and  cookery  for  the 
sick.  And  to  this  should  be  added  a  very  careful  study  of 
food  economics,  so  that  the  mother  may  be  taught  how  to  buy 
economically  as  well  as  cook  properly  the  desirable  food  for 
her  family. 

To  become  an  expert  in  her  field,  the  nurse  must  go  still 
farther — she  will  find  it  necessary  to  specialize  on  the  subject 
of  child  life,  the  physiology,  hygiene,  and  diseases  of  chil- 
dren, and  child  psychology;  she  will  study  the  history  and 
present  status  of  the  movement  in  behalf  of  conservation  of 
infant  and  child  life,  and  these  will  call  for  at  least  elementary 
courses  in  sociology,  economics,  and  vital  statistics.  She  will 
also  acquaint  herself  with  the  present  problems  and  tendencies 
of  education  in  order  to  make  herself  an  intelligent  and  sym- 
pathetic co-operator  with  teachers  and  officers  of  the  school 
system. 

Moreover,  there  are  occasional  demands  upon  the  nurse  to 
teach  elementary  hygiene  in  the  younger  grades.  To  do  this 
requires  the  same  special  preparation  as  is  demanded  for 
regular  teachers,  but,  granting  the  nurse  is  thus  equipped, 
she  should  be  exceptionally  capable  of  presenting  the  subject 
of  hygiene  in  a  telling  and  vivid  way. 

There  is  still  another  tendency  in  some  places,  i.  e.,  to 
place  the  sanitary  supervision  of  the  school-buildings  in  the 
hands  of  the  school  nurse,  and  there  can  be  little  doubt  that  a 
vastly  higher  standard  of  common  cleanliness  would  prevail 
in  our  schools  if  nurses  were  given  some  authority  in  this  de- 
partment of  school  hygiene.  It  is  freely  acknowledged  by 
some  sanitary  experts  that  nurses  make  the  best  inspectors 
of  homes.  In  the  light  of  recent  investigations  made  by  the 
Russell  Sage  Foundation'  and  others  revealing  conditions  of 
uncleanliness  in  some  of  our  schools  which  are  a  constant 
menace  to  the  health  of  the  children,  it  cannot  be  too  much 

'See  Report  No.  loi,  "Department  of  Child  Hygiene." 


TRAINING   OP   SCHOOL-HEALTH   WORKERS  533 

to  say  that  the  conscience  and  intelligence  of  a  trained  woman 
could  well  direct  the  activities  of  the  ordinary  school  janitor. 

Summary  of  Professional  Training  Needed. — The  nurse 
who  would  adequately  prepare  herself  for  expert  service  as  a 
school  nurse  should  add  to  her  general  hospital  training  the 
following : 

(i)  Special  theory  and  practical  experience  in  the  care 
and  study  of  infants  and  children,  including  general  diseases 
of  childhood,  contagious  and  skin  diseases,  and  those  of  eye, 
ear,  nose,  and  throat. 

(2)  Special  dietaries  and  food  economics  and  nutrition. 

(3)  Physiology,  hygiene,  and  psychology  of  childhood. 

(4)  History  of  the  movements  in  behalf  of  child  welfare. 

(5)  Domestic  and  municipal  sanitation,  including  house 
construction. 

(6)  Principles  and  methods  of  relief. 

(7)  Principles  and  methods  of  teaching. 

(8)  All  of  these  will  have  their  foundation  in  at  least  the 
elements  of  sociology,  economics,  and  vital  statistics. 

Departments  providing  such  training  are  now  established 
in  several  of  our  universities,  and  certain  elementary  courses 
of  instruction  are  provided  for  those  whose  work  brings  them 
every  day  into  the  midst  of  social  problems  and  compels  them 
to  take  at  least  the  first  steps  toward  a  proper  handling  of 
those  problems. 

Nurses  themselves  are  painfully  conscious  of  their  in- 
sufficient preparation  for  this  important  work,  which  is  fast 
assuming  the  proportions  of  a  national  service,  and  are  in 
steadily  increasing  numbers  seeking  to  supplement  their 
hard-earned  experience  with  more  fundamental  knowledge. 

Therefore,  while  the  claims  made  in  the  beginning  of  this 
paper,  i.  e.,  that  in  spite  of  her  meagre  preparation  the  school 
nurse's  work  has  been  to  a  large  degree  efifective  and  that  she 
has  already  become  an  indispensable  factor  to  the  cause  of 
school  hygiene,  still  we  confidently  assure  our  friends  and  co- 
workers, the  teachers  and  doctors,  that  each  year  will  witness 


534  EDUCATIONAL   HYGIENE 

a  substantial  lengthening  of  the  role  of  adequately  prepared 
women  to  direct  the  work  of  school  nursing. 

Training  of  Supervisors  of  Hygiene  and  Assistant  Physi- 
cians.— The  average  physician  is  poorly  trained  for  school- 
health  work.  Few  medical  schools  give  much  attention  to 
pediatrics,  and  the  course  is  not  usually  required.  The  gen- 
eral physician  is  usually  far  from  being  a  child  hygienist  or 
children's  physician.  Much  of  his  course  in  the  ordinar}^ 
medical  school  contributes  little  or  nothing  to  his  efficiency 
in  school  work.  Several  entire  courses  and  many  phases  of 
certain  subjects  could  be  omitted  from  his  training.  Disre- 
garding the  low  state  of  efficiency  of  many  medical  schools, 
according  to  Flexner's  expose,  the  whole  spirit  and  purpose 
of  these  schools  is  different  from  that  which  should  be  held 
by  the  school  physician.  Their  purpose  is  to  train  men  to 
cure  existent  disease;  his  purpose  is  to  prevent,  diagnose,  and 
help  to  get  cured,  largely  through  agents  other  than  himself, 
the  ailments  and  defects  of  school-children.  The  knowledge 
of  the  school  physician  must  be  of  children,  mentally  and  phys- 
ically; and  it  must  be  gained  from  the  standpoint  of  a  state 
official  in  public  service. 

Cities  and  rural  regions  should  demand  evidences  of  special 
training  on  the  part  of  physicians  in  the  field  of  educational 
hygiene,  especially  of  school  medical  supervision,  and  the 
supervisors  should  give  them  further  training  while  in  service. 
Where  whole-time  assistant  physicians  are  employed,  as  is 
now  becoming  the  case  in  our  largest  cities,  we  have  the  be- 
ginning of  a  new  branch  of  the  medical  profession,  or  per- 
haps rather  of  the  educational  profession,  that  will  require 
special  courses  different  from  those  usually  given  for  the 
M.D.  degree.  The  best  medical  schools  now  require  three 
years  of  college  work  and  four  years  of  medical  work,  or 
seven  years  beyond  high-school  graduation.  As  the  rapidly 
widening  field  of  school-health  work  offers  better  salaries  and 
numerous  opportunities,  arising  from  the  demands  made  by 
communities,  many  young  men  will  wish  to  make  special 
j)roparation  for  such  work. 


TRAINING   OF   SCHOOL-HEALTH   WORKERS  535 

This  specialized  course  cannot  well  be  arranged  either  at  a 
teachers'  college  or  at  a  medical  school  alone,  although  a  good 
start  could  be  made  by  adding  a  professor  of  educational  hy- 
giene to  some  of  the  best  medical  schools,  and  providing  for  dif- 
ferentiated medical  courses,  emphasizing  pediatrics,  practical 
sociology,  and  educational  hygiene,  including  medical  super- 
vision and  the  other  four  divisions  (five,  if  we  take  child 
psychology,  including  mental  tests,  etc.,  out  of  medical  super- 
vision and  make  of  it  a  separate  division).  Such  a  course, 
supplemented  by  a  period  of  service  in  a  children's  hospital 
and  dispensary,  would  be  satisfactory  for  assistant  physicians. 
The  study  of  obstetrics,  pharmacology,  and  the  diagnosis  and 
treatment  of  adult  diseases  might  be  either  omitted  or  short- 
ened, thus  giving  time  for  the  educational  work.  Such  courses 
may  ultimately  be  completed  at  an  earlier  age  than  at  present 
by  the  adoption  of  several  of  the  short-cut,  waste-eliminating 
methods  now  being  tested  experimentally  at  the  University 
of  Chicago  and  elsewhere  for  the  course  of  education  from  the 
elementary  school  up. 

The  specialized  training  in  educational  hygiene  cannot 
well  be  expected  from  part-time  school  physicians.  They 
will  require  training  in  service  by  the  supervisors  of  hygiene 
and  in  short  summer  courses  at  professional  schools;  but  by 
careful  selection  through  examinations  and  other  means  such 
physicians  may  be  selected  as  have  had  preliminary  training 
and  experience  somewhat  along  the  lines  of  child  hygiene. 
The  demand  for  such  qualifications,  backed  up  by  adequate 
salaries,  will  prompt  many  young  physicians  in  training  to 
obtain  courses  and  experience  along  these  Hnes. 

The  supervisor  of  hygiene  should  be  a  child  hygienist,  a 
doctor  of  public  health  along  school  lines,  a  practical  sociolo- 
gist, an  educator,  especially  in  the  field  of  physical  education, 
a  sanitarian,  and  a  psychologist.  Obviously,  such  all-round 
training  cannot  now  be  procured  in  a  reasonable  length  of 
time.  The  task  becomes  one  of  selecting  that  knowledge  and 
experience  which  is  of  most  worth,  and  the  development  of 
courses  which  will  provide  in  a  few  years  the  essential  ele- 


536  EDUCATIONAL  HYGIENE 

ments  necessary  for  success  in  supervising  the  several  phases 
of  health  work,  especially  medical  supervision  (including 
psychological  examinations),  school  sanitation,  and  physical 
education.  With  adequate  vocational  guidance,  such  a  train- 
ing for  many  young  men  could  begin  in  the  high  schools. 
Boys  interested  in  science,  skilled  in  play  and  athletics,  and 
with  a  capacity  for  leadership  may  easily  be  guided,  with 
benefit  to  all,  into  medicine,  and  that  form  of  public  prevent- 
ive medicine  which  we  here  call  educational  hygiene.  The 
college  course  preliminary  to  the  professional  training  may 
also  be  arranged  with  this  object  in  view.  The  work  in  phys- 
ical education  may  all  be  done  in  the  college  course,  perhaps, 
so  that  the  young  man  need  spend  little  time  in  the  study  of 
physical  education,  normal  diagnosis,  etc.,  after  graduation 
from  college.  Of  course,  he  must  know  more  of  this  field 
than  the  teachers  of  physical  education  he  supervises,  at  least 
in  a  general  way.  Obviously,  too,  a  supervisor  so  trained  will 
command  a  salary  of  two  to  four  thousand  dollars  when  he  is 
ready  to  take  up  his  work.  Several  cities  are  now  paying 
this  amount,  and  the  tendency  is  strong  in  the  direction  of 
the  appointment  of  such  men.  New  York  City  has  recently 
appointed  several  educational  hygienists  at  good  salaries  by 
competitive  examinations. 

Physical-Educationists. — Numerous  excellent  courses  at 
various  institutions  provide  to-day  fairly  satisfactory  training 
for  those  who  wish  to  take  up  the  work  of  physical  education 
in  schools.  Some  persons  specialize  in  play  and  playground 
management,  others  in  physical  training  and  gymnastics, 
others  in  folk-dancing,  others  in  athletics,  and  still  others  in 
aquatics,  etc.  The  supervisor  of  hygiene  will,  of  course, 
take  an  all-round  course,  and  should  have  practical  experi- 
ence in  this  work,  perhaps,  before  taking  a  position  as  general 
supervisor.  The  regular  teachers  and  supervisors  of  physical 
education  should  also  have  wide  acquaintance  with  the  various 
forms. 

The  training  at  present  is  weak  along  the  lines  of  general 


TRAINING   OF    SCHOOL-HEALTH   WORKERS  537 

education,  of  sociology,  and  of  medicine,  although  a  marked 
tendency  exists  at  the  best  institutions  in  the  direction  of 
broadening  such  work.  In  many  places  the  teacher  of  phys- 
ical training  or  the  playground  instructor  may  make  very 
grave  errors  in  attempting  to  train  children  who  need  pre- 
liminary medical  examination  and  direction.  Some  work  in 
normal  and  pathological  diagnosis  should  be  provided  in  such 
courses.  Doctor  Hoag  and  others  assert  that  teachers  can  be 
trained  to  detect  80  per  cent  of  the  important  and  serious 
defects  and  ailments  of  school-children,  and  the  physical- 
educationist  should  be  even  better  able  to  do  this.  Frequently 
he  meets  all  the  children  of  a  school  several  times  a  week  in  a 
way  that  easily  makes  possible  preliminary  medical  inspection. 
Meeting  such  a  responsibility  will  broaden  him  and  his  pro- 
fession, and  this  should  be  foreseen  in  his  professional  courses. 
Medical  gymnastics,  and  the  examination  of  vision  and  hear- 
ing, should  also  be  taught.  The  best  courses  now  include  a 
reasonable  amount  of  teaching  of  health  and  hygiene,  and 
the  physical-educationist  should  be  well  versed  in  this  field. 
School  hygiene  may  well  be  made  a  part  of  the  course  for  all 
those  who  would  teach  this  subject. 


CHAPTER  XXVIII 
INDUSTRIAL  HYGIENE  AND  VOCATIONAL  EDUCATION 

The  Anomaly. — To  those  who  have  studied  the  pressing 
problems  of  working  people,  a  serious  anomaly  appears  in 
American  industrial  education.  The  movement  for  industrial 
education  has  been  a  most  desirable  effort  to  help  the  great 
masses  of  our  people  solve  successfully  through  pubHc  educa- 
tion one  of  the  most  serious  problems  of  life — that  of  making 
a  living.  A  rough  analysis  of  this  problem  has  associated 
vocational  preparation  with  forges  and  lathes,  special  schools, 
and  costly  apparatus.  Educators  have  clamored  long  and 
loudly  for  appropriations  with  which  to  begin  this  work. 
They  have  said:  We  can  do  nothing  until  we  get  the  money 
with  which  to  purchase  this  equipment.  And  they  have 
done  nothing  without  it. 

Now  a  more  thorough  survey  of  the  prime  needs  of  the 
world's  workers  will  reveal  two  very  essential  and  funda- 
mental factors  of  vocational  education  which  most  indus- 
trial courses  and  schools  very  largely  overlook,  and  which 
are  moreover  comparatively  inexpensive.  These  are,  first, 
the  development  of  general  industrial  intelligence,  including 
acquaintanceship  with  the  complex  industrial  world  of 
the  present;  and,  secondly,  thoroughgoing  education  in  gen- 
eral, industrial,  and  occupational  hygiene.  While  they  are 
waiting  for  appropriations,  school  systems  could  be  giving, 
without  very  great  outlays  of  money,  fundamental  instruction 
with  regard  to  our  complex  industrial  life,  and  this  invalu- 
able health  education  largely  by  the  use  of  the  schoolmaster's 
favorite  instrument — the  book,  a  simple,  inexpensive  tool. 

538 


HYGIENE  AND   VOCATIONAL  EDUCATION  539 

Health  Education  for  Workers  as  Vocational  Education.^ — 

Let  us  glance  at  just  one  of  these  propositions — that  in 
reference  to  health  education  for  workers  as  primary  voca- 
tional education.  What  is  the  health  problem  for  our  work- 
ing people  ?  From  extensive  studies  of  mortality  statistics 
and  the  data  of  private  and  public  insurance  agencies  here 
and  abroad,  as  well  as  from  many  special  studies,  we  learn 
with  respect  to  the  illness  problem  that  there  are  in  this  coun- 
try not  less  than  13,000,000  cases  of  sickness  each  year  among 
those  engaged  in  industrial  pursuits.  The  effects  of  such 
illnesses  are  well  known.  Illness  reduces  bodily  efficiency, 
causes  losses  of  work  and  of  wages,  and  frequently  ends  in 
death.  Webb,  Devine,  and  other  social  students  and  workers 
are  agreed  that  to  the  sickness  of  workers  is  directly  due 
over  25  per  cent  of  all  poverty  and  destitution. 

Health  Conditions  of  Workers. — Rubinow,  in  his  "  Social 
Insurance,"  reports  that  in  Austria,  where  the  government 
insures  workers  against  illness  and  where  accurate  records  are 
kept  of  the  illness  problem  of  workers,  with  nearly  three  mil- 
lion workers  insured  in  1907,  there  occurred  1,623,000  cases 
of  sickness,  causing  a  loss  of  28,000,000  days.  Fifty-three 
per  cent  of  the  entire  working  army  suffered  such  loss,  and  the 
average  time  lost  was  17  days  each.  How  much  of  low  vital 
working  efficiency  there  resulted  could  not  well  be  measured. 

In  Germany,  with  over  13,000,000  insured  against  sick- 
ness, there  were  (in  1908)  5,200,000  cases  of  illness,  or  40 
per  hundred  persons,  and  the  number  of  days  lost  was  104,- 
000,000,  or  20  days  for  each  case  of  sickness,  and  an  aver- 
age of  eight  days  for  each  of  the  thirteen  million  insured. 
Of  course,  these  are  only  partial  costs,  since  the  public  taxa- 
tion for  public  hospitals  and  other  such  health  agencies  is 
not  here  included,  and  still  other  costs  are  omitted.   , 

Since  we  have  as  yet  in  this  country  no  such  systems  of 
social  insurance,  we  do  not  yet  have  accurate  statistics  of  the 
health  problem  of  our  own  workers.     But  these  illness  losses 

'  This  chapter  appeared  in  the  Educational  Review  for  December,  1914. 


540  EDUCATIONAL  HYGIENE 

may  from  several  sources  be  computed  as  an  average  of  over 
two  weeks  of  work  and  not  far  from  5  to  15  per  cent  of  the 
workers'  annual  wages,  including  medical,  burial,  and  other 
such  expenses,  both  private  and  public.  When  we  study 
the  annual  wages  of  our  workers,  a  large  proportion  of  them 
now  being  industrial  wage-earners  of  the  factory  type,  and 
find  that  the  median  annual  wage  is  not  far  from  $650  to 
$700,  and  that  this  sum  is  hardly  up  to,  and  certainly  not 
above,  the  minimum  amount  necessary  for  a  family  with 
which  to  maintain  a  minimum  standard  of  living — when  we 
see  our  industrial  population  working  so  close  to  this  mini- 
mum— then  we  realize  what  the  direct  and  indirect  loss  of 
even  one-twentieth  of  the  annual  wages  for  sickness  really 
means,  especially  when  we  learn  further  that  about  50  per 
cent  of  it  is  reasonably  preventable.  Our  working  people 
cannot  afford  it. 

Yet  such  data  scarcely  show  up  the  complete  death  and 
lowered  vital  efficiency  problems  of  workers.  Over  one- 
fifth  of  the  children  brought  into  the  world  each  year,  at 
such  cost,  die  in  the  first  year;  one-fourth  are  dead  before 
the  age  of  five;  and  half  of  all  born  into  the  homes  of  our 
workers  die  before  the  age  of  twenty-three.  Over  1,600,000 
of  our  total  population  die  each  year,  100,000  of  them  of 
school  age.  This  is  an  annual  loss  of  about  2  per  cent  of 
our  total  population,  which,  in  an  enlightened  civilisation, 
is  about  double  what  it  should  be. 

We  cannot  avoid  the  conclusion  that  the  most  fundamental 
form  of  general  and  vocational  training  is  that  which  would 
enable  the  working  population  to  meet  more  effectively  these 
death,  illness,  and  lowered  vital  efficiency  losses.  More- 
over, the  young  men  and  women,  the  boys  and  girls  of  our 
schools,  very  much  need  this  type  of  vocational  education  be- 
cause they  themselves  are  seriously  defective  and  ailing. 
Doctor  Chisholm's  studies  of  the  girls  preparing  for  work  in 
Manchester,  England,  the  great  amount  of  data  collected  in 
our  medical  supervision  of  schools,  and  the  statistics  of  ex- 


A  special  class  in  Albany,  N.  Y. 

Three-fourths  of  the  programme  is  devoted  to  hand-work  and  special  activities.     The  freedom 
and  happiness  of  the  children  is  the  striking  feature 


A  group  of  ungraded  school-children,  Albany,  N.  Y. 
Nine  different  lines  of  hand-work  are  represented 


HYGIENE  AND   VOCATIONAL  EDUCATION  54 1 

aminations  for  army  recruits  and  for  those  entering  industry 
abroad,  all  show  the  extreme  importance  of  complete  and 
thoroughgoing  systems  of  educational  hygiene  for  our  work- 
ing i^eople. 

Health  and  the  Working  Girl. — Mrs.  Woolman  says  of 
the  girls  entering  the  Manhattan  Trade  School  for  Girls: 
"The  young  wage-earner  who  goes  into  trade  untrained  at 
fourteen  years  of  age  is  greatly  handicapped  by  her  physical 
condition.  Either  through  ignorance  or  neglect,  early  symp- 
toms of  disease  are  disregarded,  and  it  is  not  until  she  finds 
herself  out  of  employment  as  a  result  of  physical  weakness 
that  she  realizes  that  good  health  is  the  capital  of  the  working 
girl."  And  again:  "The  young  wage-earner  ...  is  much 
handicapped  by  her  physical  condition;  heredity,  poor  habits 
of  life,  and  insanitary  homes  show  their  effects  on  her.  The 
girls,  however,  are  young  enough  to  remedy  many  of  their 
defects.  In  a  few  months  they  will  be  in  positions  demanding 
eight  or  more  hours  a  day  in  which  they  must  strain  every 
nerve  and  bend  all  their  energies  to  meet  the  standard  brought 
about  by  trade  competition." 

We  do  not  need  to  demonstrate  by  the  statistical  studies 
that  have  been  made  that  the  general,  the  industrial,  and 
the  occupational  hygiene  phases  of  vocational  education 
for  health  efficiency  are  wofully  neglected  in  the  schools 
of  this  country.  Our  teachers  do  not  know  the  elements 
of  general,  personal,  and  public  hygiene,  not  to  mention 
industrial  and  occupational  hygiene.  We  have  few  good 
text-books  in  hygiene  in  use,  and  little  or  no  time  is  given 
to  the  subject  as  a  school  study.  An  extensive  study  of 
actual  courses  in  vocational  education  shows  that,  with  but 
practically  one  exception,  the  only  progressive  work  of  this 
type  is  being  done  abroad.  Our  vocational  courses,  like  our 
general  elementary  and  high-school  courses,  almost  entirely 
overlook  this  form  of  vocational  preparation. 

The  anomaly,  then,  in  summary,  is  about  as  follows: 
hygienic    education    an    indispensable    phase    of    vocational 


542  EDUCATIONAL  HYGIENE 

education;  and  yet  an  almost  total  lack  or  great  inefficiency 
of  health  education,  both  general  and  vocational;  miUions 
of  workers  suffering  high  illness,  death,  and  lowered  vitality 
losses;  and  yet  the  spectacle  of  educators  clamoring  for-  the 
costly  tools  for  a  narrow  type  of  vocational  training  while 
at  the  same  time  neglecting  the  preparation  so  near,  so 
fundamental,  and  so  comparatively  inexpensive. 

What  is  Being  Done. — The  best  evidences  I  have  been 
able  to  find  of  adequate  attention  to  this  important  matter 
have  been  in  Munich,  Germany,  some  schools  of  England, 
the  schools  of  Sweden,  and  the  Manhattan  Trade  School  for 
Girls  (not  true  for  the  one  for  boys  as  yet)  in  New  York  City. 
Doctor  Kerchensteiner  in  Munich  has  not  only  medical  ex- 
aminations and  follow-up  work  and  attention  to  sanitation 
and  physical  education,  but  he  has  a  regular  course  intended 
to  give  intelligence  with  respect  to  the  complex  industrial 
and  civic  world  of  to-day  and  the  elements  of  general,  indus- 
trial, and  occupational  hygiene.  His  course  is  called  Civics 
and  Hygiene. 

Sweden  has  all  these  features  but  adds  to  them  a  most 
progressive  feature  in  the  form  of  health  vocational  guid- 
ance and  follow-up  work,  including  annual  medical  examina- 
tions by  government  medical  examiners  until  the  youth 
reaches  the  age  of  eighteen.  A  young  man  may  be  changed 
from  occupation  to  occupation;  he  may  be  given  shorter 
hours  and  guidance  as  to  his  health  regimen;  and  may  even 
be  kept  out  of  work  altogether  until  he  is  physically  fit. 
In  England,  medical  supervision  and  follow-up  work  with 
some  health  vocational  guidance  is  rapidly  making  its  way. 
In  these  countries  the  insurance  of  workers  against  sickness 
by  the  state  makes  the  problem  of  health  preparation  perhaps 
not  such  an  acute  one  as  here,  yet  these  countries  are  leading 
the  way  in  school-health  work. 

An  American  Example. — The  Manhattan  Trade  School 
for  Girls  gives  each  girl  careful  physical  examinations,  an- 
nually or  more  often,  and  supplements  this  with  thorough 


HYGIENE  AND   VOCATIONAL   EDUCATION  543 

follow-up  work;  the  home  and  school  environments  are  made 
as  sanitary  as  possible;  medical,  corrective,  and  recreational 
gymnastics,  including  plays  and  games,  are  much  used, 
meeting  individual  and  class  needs;  there  is  a  great  deal  of 
practical  teaching  of  general  personal  and  public  hygiene,  and 
of  the  most  usable  phases  of  industrial  hygiene,  developing 
later  into  specific  occupational  hygiene  for  those  going  into 
definite  trades.  Last,  but  quite  important,  is  careful  guidance 
and  follow-up  work  along  sanitary  and  personal-health  Hues 
after  the  girls  have  gone  into  industry.  Further  than  these 
few  examples,  we  can  point  to  little  that  is  worth  while. 

Employers  Awakening  to  Health  as  Capital. — The  recent 
success  of  the  Life  Extension  Institute  in  getting  employers 
of  hundreds  and  thousands  of  working  people  to  furnish 
each  one  free  of  charge  with  an  annual,  very  thoroughgoing 
medical  examination,  and  the  remarkable  revelations  of  the 
low  health  status  of  most  of  these  industrial  workers,  show 
what  the  world  of  industry  is  beginning  to  think  of  thorough 
health  education  from  the  earliest  years  on.  It  moreover  in- 
dicates that  we  are  here  on  the  right  track. 

What  Must  be  Done. — Now  we  have  seen  the  anomaly 
and  what  is  being  done  in  a  few  places  here  and  abroad  to 
eliminate  it.  Let  us  next  see  what  in  this  country  must  be 
done  along  this  line.     Briefly  we  must  have: 

(i)  Thoroughgoing  medical  supervision  of  all  school- 
children, and  those  before  and  after  the  school  years  so  far 
as  possible,  especially  annual  or  more  frequent  examinations 
and  follow-up  work  of  a  corrective  and  preventive  character. 

(2)  An  improved  sanitary  environment  at  home,  in  school, 
and  at  work. 

(3)  Adequate  individual  and  collective  physical  education, 
including  medical  and  corrective  gymnastics,  plays,  games, 
recreation,  etc. 

(4)  Improved  teaching  of  hygiene,  general  personal  and 
public,  general  industrial,  and  occupational  hygiene,  each 
person  getting  as  much  of  each  as  is  reasonably  possible. 


544 


EDUCATIONAL  HYGIENE 


(5)  Careful  health  vocational  guidance  up  to  the  age  of 
eighteen  or  twenty  if  possible. 

School-Health  Work. — Elementary  and  high  schools  must 
pay  more  attention  to  these  phases  of  health  education,  using 
teachers  who  have  improved  health  training,  and  text-books 
superior  to  those  in  vogue,  along  the  lines  perhaps  of  the 
Gulick,  the  O'Shea,  and  the  Ritchie  series.  In  the  year  or  so 
before  pupils  go  out  into  industry,  they  must  have  added  to 
their  instruction  some  general  industrial  hygiene  such  as  is 
desirable  for  all  workers  of  their  kind.  And,  third,  if  pos- 
sible, they  must  have  some  knowledge  of  the  special  hygienic 
precautions  necessary  in  the  special  occupation  the  pupils  are 
sure  to  take  up,  occupational  hygiene.  Those  going  into  teach- 
ing, for  example,  must,  in  their  professional  training,  know 
the  hygiene  of  their  occupation,  namely,  teaching;  those  going 
into  the  lead  industries  must  know  how  to  meet  the  lead- 
poisoning  problem;  and  so  on. 

Hygiene  Texts  for  Vocational  and  Social  Preparation. — 
Fortunately,  some  good  texts  are  being  published  which 
will  aid  in  the  teaching  side  of  the  problem,  including  gen- 
eral personal  and  public  hygiene,  and  general  industrial 
hygiene.  I  take  time  to  mention  one  entitled  "Hygiene  for 
the  Worker,"  by  Tolman,  a  text-book  on  personal,  pubhc,  and 
industrial  hygiene  which  hooks  on  to  the  keen  interest  of 
children  to  go  out  into  industry,  and  which  sets  them  at 
work  in  direct  industrial  preparation  in  the  ways  of  health 
knowledge,  health  ideals,  and  health  habits  of  value  to  them 
as  workers.  The  chapter  headings  of  this  volume  may 
indicate  the  wealth  of  modern  hygienic  knowledge  recently 
developed  which  can  now  be  put  at  the  disposal  of  those 
who  wish  to  help  our  working  people  to  get  fundamental 
preparation  for  their  work. 

These  chapter  headings  are  as  follows:  "Applying  for  the 
Position,"  "Preparing  for  the  Day's  Work,"  "Good  Habits 
for  the  Worker,"  "Suitable  Clothing,  Food,  and  Drink," 
"Alcohol  and  Tobacco,"  "The  Noon  Hour,"  "Hygiene  of  the 


HYGIENE   AND   VOCATIONAL   EDUCATION  545 

Workroom,"  "Fatigue,"  "After  Hours,"  "Holidays  and 
Outings,"  "Choice  of  an  Occupation,"  "Occupational  Dan- 
gers," "Accidents,"  "Poisons  and  Fumes,"  "Fire,"  "First 
Aid  to  the  Injured,"  "What  the  Worker  Has  a  Right  to  Ex- 
pect," "Seasonal  Hygiene  and  Tuberculosis."  This  is  the 
best  attempt  made  so  far  to  meet  the  need  of  a  text  in  indus- 
trial hygiene  for  prospective  workers. 

Another  new  and  high-class  text  for  upper  grades  and 
high  school  but  more  general  in  its  appeal  and  in  its  subject- 
matter,  yet  of  very  great  importance,  is  Coleman's  "The 
People's  Health."  This  volume  will  be  a  good  introduction 
to  special  industrial  hygiene  for  those  who  go  on  into  or 
through  high  schools  and  trade  schools  of  secondary  grade. 
The  chapter  headings  will  here  again  give  an  idea  of  the 
wealth  of  subject-matter  available  for  vital  preventive  medi- 
cine in  the  way  of  education  in  general  and  industrial  hygiene, 
namely:  "The  Need  of  Public  Hygiene,"  "Fresh  Air  and 
the  Prevention  of  Disease,"  "The  Prevention  of  Disease  by 
Pure  Water,"  "Clean  Milk  and  the  Prevention  of  Disease," 
"Pure  Food  and  Pure  Food  Laws,"  "Food  Values  and 
Economy  in  Food,"  "The  Prevention  of  Infection,"  "Human 
Carriers,"  "Insect  Carriers,"  "Hygiene  of  Work  and  Play," 
"Mental  Hygiene,"  "A  Sanitary  Home,"  "School  Sanita- 
tion," "The  Pubhc  Health  Department,"  "Health  and  City 
Life,"  "Rural  Sanitation,"  "Industrial  Hygiene,"  and  "A 
Sound  Body  Conquers  Disease."  This  volume  is  even  more 
profusely  illustrated  with  remarkably  telHng  illustrations 
than  the  former. 

Dr.  Florence  Richards  has  published  also  a  practical 
"Hygiene  for  Girls,"  which  is  of  the  new  order. 

The  Public  School  and  the  Public  Health.— Here,  then, 
we  have  a  tentative  programme  for  helping  vocational  edu- 
cation to  enlarge  its  service,  slightly  beyond  the  giving  of 
mere  trade  skill,  to  help  the  workers  of  the  country  meet  in  a 
healthy,  vigorous  manner  these  serious  problems  of  life  and 
attain  genuine  social  efficiency  so  long  held  to  be  the  aim  of 


54(>  EDUCATIONAL  HYGIENE 

education.  It  may  seem  a  somewhat  progressive  programme, 
but  it  is  not  in  any  sense  ultra.  As  Seager  says  in  his  "  Social 
Insurance":  "In  the  United  States  we  are  still  so  far  from 
considering  illness  as  anything  beyond  a  private  misfortun- 
against  which  each  individual  and  each  family  should  prote:^, 
itself  as  best  it  may,  that  Germany's  heroic  method  of  attack 
ing  it  as  a  national  evil  through  governmental  machinery 
seems  to  us  to  belong  to  another  planet."  But  this  feeling 
will  soon  pass;  and  the  governmental  machinery  we  should 
chiefly  use  in  this  democratic  country  is  the  machinery  of  our 
public  schools,  especially  our  industrial  courses  and  schools.' 

'  The  State  of  Wisconsin  has  recently  entered  the  field  of  public  industrial 
insurance.  This  will  soon  show  the  condition  of  the  working  population  with 
respect  to  health  and  will  indicate  a  needed  reform  in  vocational  education. 


CHAPTER  XXIX 
SEX  HYGIENE  AND  SEX  EDUCATION 

Sex  Education. — Sex  hygiene  is  a  term  that  has  come  into 
popular  usage  to  indicate  a  phase  of  education  which  has 
escaped  the  attention  of  educators,  owing  to  the  ignorance  of 
its  importance  as  well  as  to  the  inhibiting  force  of  tradition  and 
taboo.  In  its  general  significance,  it  embraces  all  the  themes 
which  centre  about  the  sex  characteristics  of  the  species. 
It  has  a  special  meaning  to  various  teachers  according  to  their 
basic  interests.  Some  educators  are  carried  away  by  the  idea 
that  merely  teaching  the  facts  of  reproduction  constitutes  sex 
hygiene.  Various  other  teachers  and  writers  regard  the  facts 
concerning  the  social  evil,  the  venereal  diseases,  or  eugenics, 
as  the  main  elements  of  information  to  be  imparted  in  sex 
hygiene.  These  conceptions  are  obviously  limited.  While 
each  constitutes  one  phase  of  the  sex  problem,  it  by  no  means 
encompasses  the  field  of  sex  hygiene. 

From  the  standpoint  of  education,  the  term  sex  hygiene  is 
a  misnomer.  Sex  physiology,  sex  pedagogy,  or  sex  ethics 
would  equally  describe  the  educational  content  of  a  course  of 
study  designed  to  yield  to  youthful  minds  the  body  of  facts 
essential  for  their  wholesome  development.  The  preferable 
and  comprehensive  term  for  the  field  in  the  mind  of  educators 
is  sex  education.  This  includes  the  natural  training  of  children 
along  rjonnal  lines  in  their  duties  and  responsibilities  for  the 
development  and  maintenance  of  their  manhood  and  woman- 
hood, and  involves  preparing  them  for  their  highest  duties  as 
the  potential  parents  of  future  generations.  A  slight  knowl- 
edge of  anatomy  is  essential.  Physiology  naturally  must  be 
interpreted  in  terms  of  hygiene.     All  instruction  would  fail 

547 


548  EDUCATIONAL  HYGIENE 

in  effective  results  were  it  not  based  upon  an  intelligent  un- 
derstanding of  sex  psychology  and  sex  ethics.  The  methods 
of  imparting  instruction  would  be  blind  and  chaotic  without 
a  lull  appreciation  of  the  methods  and  values  bound  up  in 
sex  pedagogy.  Sex  knowledge,  sex  understanding,  and  sex 
interpretation  are  equally  indispensable. 

Correlation  of  Sex  Education  with  General  Education.^ 
Owing  to  the  fact  that  the  importance  of  sex  education  has 
suddenly  dawned  upon  the  educational  world,  it  has  been  im- 
mersed in  an  unusually  strong  light,  and  singled  out  as  an 
isolated  subject  free  from  correlation  with  the  rest  of  the 
school  curriculum.  This  unfortunate  point  of  view,  arising 
from  the  concentrated  attention  now  bestowed  on  the  subject, 
loses  sight  of  the  fact  that  sex  education  is  not  essentially  a 
separate  educational  problem,  but  is  intricately  interwoven 
in  the  fabric  of  general  education.  Assuming  that  education 
implies  the  imparting  of  the  facts,  processes,  and  ideals  es- 
sential for  the  development  of  effective  citizenship,  it  cannot 
be  denied  that  training  for  parenthood  is  involved  in  the  gen- 
eral function  of  education.  As  courses  of  study  are  at  pres- 
ent developed,  there  is  a  prevailing  habit  to  omit  all  conscious 
references  to  the  facts  pertaining  to  sex,  in  so  far  as  they  may 
arise  in  the  study  and  teaching  of  various  subjects  now  in- 
cluded in  the  curriculum.  It  is  patent  that,  to  properly 
interpret  mythology,  a  thoughtful  mind  could  receive  a  wide 
education  in  facts  pertaining  to  sex  that  would  make  no  im- 
press upon  the  youthful  minds  save  as  related  to  mythology. 
The  interpretation  of  the  literature  of  all  nations  involves  a 
close  attention  to  sex  evolution,  sex  facts,  and  sex  content 
that  affords  abundant  opportunity  for  the  gradual  and  normal 
inculcation  of  sex  idealism.  History,  music,  n^jffti^-^tudy, 
sociology,  botany,  and  biology  are  practically "  c^J^fi^ers  of 
broad  lessons  in  sex  education  which  have  largely  been  neg- 
lected, owing  to  the  fear  of  polluting  the  child  mind  with 
sex  facts  tending  to  moral  degeneration.  Religious  instruc- 
tion itself,  based  upon  the  use  of  the  Bible,  cannot  be  ade- 


SEX   HYGIENE   AND   SEX   EDUCATION  549 

quately  developed  without  opening  up  to  the  child  mind 
vistas  of  thought  to  be  appreciated  only  in  the  light  of  an  in- 
telligent understanding  of  the  vocabulary  contained  in  the 
Bible  itself.  The  Bible  has  not  been  utilized  as  its  content 
warrants  for  the  giving  of  sex  education.  Its  use  has  been 
neglected  almost  entirely  by  the  religious  teachers  in  whose 
hands  for  centuries  has  been  the  problem  of  moral  education 
of  the  youth. 

The  Problem  of  the  School. — Considerable  agitation  has 
arisen  over  the  suggestion  that  sex  education  be  imparted  to 
the  young.  The  fundamental  opposition  has  arisen  from  a 
failure  to  recognize  that  sex  education  is  constantly  being 
acquired  by  children.  Furthermore,  there  has  been  a  possible 
lack  of  understanding  that  the  real  problem  does  not  consist 
in  determining  whether  sex  education  should  be  given  to  chil- 
dren, but  under  what  conditions  and  by  which  teachers. 
Ignorance  and  innocence  in  childhood,  in  so  far  as  sex  themes 
are  concerned,  are  not  one  and  the  same  thing.  There  may 
be  chastity  with  a  full  knowledge  and  understanding  of  the 
facts  of  life,  or  there  may  be  gross  immorality  without  any 
true  knowledge  of  the  underlying  physiology  or  hygiene  of  sex 
life. 

The  great  problem  for  educators  to  determine  is  whether 
they  are  to  assume  the  responsibiUty  for  the  normal  and  health- 
ful instruction  of  the  young  with  regard  to  the  facts  pertain- 
ing to  sex,  or  whether  they  are  to  continue  to  permit  childhood 
to  gain  its  information  from  corrupt  and  foul  sources,  from 
erotic  literature,  or  from  the  evil  traditions  of  the  gang. 
Ob viouslyJIJ^  teacher  cannot  shirk  his  responsibility,  while 
educati^l^a^^^-ned  essential  for  the  betterment  of  the  human 
race.  «yt1iroug]i  the  error  of  centuries  sex  education  has  been 
negle(^Pl^'aes^e  its  important  educational  value,  then  it  is 
incumbent*  upon  the  teachers  to  realize  the  existent  necessity 
for  imparting  sex  instruction  and  to  ascertain  the  methods 
best  calculated  to  prove  effective. 

Sex  education  merits  careful  consideration  because  it  is 


550  EDUCATIONAL  HYGIENE 

an  essential  feature  of  the  implied  educational  value  of  edu- 
cation itself.  The  taboo  which  has  existed  since  creation  is 
gradually  being  raised.  The  traditions  involving  different 
standards  of  morality  for  the  two  sexes  have  been  the  cause 
of  great  social  waste  and  devastation,  and  are  opposed  to 
race  progress.  The  church,  the  home,  and  the  school  have 
uniformly  and  consciously  avoided  giving  the  essential  in- 
formation for  proper  sex  conduct,  despite  the  fact  that  such 
neglect  has  brought  untold  suffering  to  humanity.  In  the 
inculcation  of  virtues,  stress  is  placed  upon  honesty,  justice, 
chastity,  courage,  kindliness,  and  honor,  but  in  so  far  as  these 
values  are  to  be  secured  through  a  conscious  appeal  to  sex 
psychology  and  sex  control,  education  has  been  wofully  silent 
and  indifferent. 

The  basis  of  family  life,  as  a  unity  for  the  development  of 
society,  is  founded  upon  the  development,  direction,  and  con- 
trol of  the  sex  instinct.  As  the  basis  of  love,  physical  or 
spiritual,  the  sex  instinct  demands  guidance  and  development 
in  the  interests  of  racial  progress.  Unfortunately,  the  ordi- 
nary approach  to  the  subject  of  sex  education  has  been  from 
the  pathological  side.  A  recognition  of  the  horrors  of  the 
social  evil,  and  an  appreciation  of  the  relation  of  the  venereal 
diseases  to  blindness,  idiocy,  and  racial  deterioration,  have 
served  as  the  starting-point  for  demanding  conscious  sex  in- 
struction as  a  palliative  measure.  From  this  point  of  ap- 
proach, it  is  easy  to  understand  why  teachers  have  feared  to 
discuss  the  subject.  The  traditional  barriers  of  modesty 
and  fear  have  created  a  position  so  difficult  that  few  teachers 
have  had  the  courage  to  attempt  to  devj^^^nethod  for 
dispersing  ignorance  and  giving  enlightenii^^^^fc|ft  the  un- 
derlying facts  necessarily  to  be  imparted  ^^^^^^^  lessen 
these  social  ravages.  ^^^^^^f 

A  few  educators,  with  an  understanding^^HBmore  seri- 
ous problems  involved,  have  sought  to  discoverThe  basic  facts^ 
pertaining  to  sex  which  should  be  imparted  to  children,  and 
have  sought  to  devise  methods  for  offering  this  instruction. 


SEX   HYGIENE   AND    SEX   EDUCATION  551 

They  have  come  to  realize  that  a  constructive  plan  of  sex  ed- 
ucation, pedagogically  analyzed,  involves  a  full  recognition 
of  the  part  that  sex  plays  in  social  development  and  personal 
progress. 

As  a  result  of  analysis,  sex  education  no  longer  can  be  re- 
garded as  a  special  subject  isolated  from  the  rest  of  life.  Sex 
hygiene  is  bound  up  in  all  the  subjects  of  the  curriculum.  Be- 
cause of  the  attempts  to  isolate  it  from  the  other  subjects  in 
the  curriculum,  it  has  assumed  a  monstrous  form,  astonishing 
and  stupefying  those  seeking  only  the  dangers  in  the  impart- 
ing of  sex  instruction.  If  sex  education  were  to  be  classified 
as  a  specific  carnal  subject,  it  would  present  most  tremen- 
dous difficulties.  Constituting  a  part  of  general  education, 
however,  it  so  sinks  its  identity  in  the  various  subjects  now 
taught  as  to  deprive  it  of  the  dangers  and  salacious  tendencies 
so  greatly  feared.  Sex  instruction  should  be  approached  in 
a  normal  manner,  evaluating  sex  facts  in  terms  of  the  child 
mind.  The  great  obstacle  to  giving  such  instruction  has 
arisen  from  the  fact  that  adults  rich  in  experience,  saturated 
with  tradition,  and  conscious  of  sex  physiology  have  failed  to 
appreciate  the  spiritual,  ethical,  and  scientific  values  of  the 
subject  as  they  may  be  developed  in  the  plastic  and  undefiled 
minds  of  children.  Pedagogical  hesitancy  has  been  founded 
upon  a  failure  to  interpret  the  facts,  the  processes,  and  the 
ideals  involved  in  sex  education  in  terms  of  children's  under- 
standing. 

Sex  Education  According  to  Stages  of  Child  Development. 
— It  is  patent  that  sex  education  is  neither  a  special  subject 
nor  one  Jj^fci  essentially  to  any  period  of  child  development. 
Virtual^HH^lucation  is  a  constant  process  extending  from 
infamy  to  rnaiurity  and  even  until  senility.  The  methods 
devi^d  for  i  Jfruction  in  Uterature,  mathematics,  history,  and 
nature^JffiHpRaturally  vary  at  different  periods  of  the  psycho- 
logical development  of  children.  Similarly,  the  methods  em- 
ployed in  imparting  sex  instruction  must  vary  according  to 
the  age,  sex,  family  environment,  nationality,  sex  precocity, 


552  EDUCATIONAL   HYGIENE 

and  mental  development  of  children.  For  the  purpose  of 
convenience  in  considering  educational  methods  to  be  em- 
ployed, it  has  been  suggested  by  a  committee  of  the  American 
Federation  of  Sex  Hygiene  that  the  matters  and  methods  of 
sex  education  should  vary  according  to  more  or  less  definite 
age  periods,  as,  for  example:  one  to  six  years,  six  to  twelve 
years,  twelve  to  sixteen  years,  and  sixteen  years  and  there- 
after. From  the  standpoint  of  the  psychological  develop- 
ment of  children,  regardless  of  distinct  chronological  limita- 
tions, I  have  suggested  that  the  matter  and  methods  of  sex 
education  be  divided  according  to  three  stages  of  child  de- 
velopment, which  I  have  termed  the  age  of  mythology,  the 
age  of  chivalry,  and  the  age  of  civic  awakening. 

The  age  of  mythology  constitutes  that  period  of  child  life  that  is 
particularly  keen  in  imagination.  Mentally,  the  fairy-tale,  the  ro- 
mance, the  animal  story,  and  nature  wonders  supply  the  best  intel- 
lectual pabulum. 

Gradually  the  child  outgrows  the  age  of  mythology  and  enters 
the  age  of  chivalry.  There  is  no  sharp  line  of  demarcation  of  the  two 
periods,  nor  can  any  age  be  given  when  the  transition  occurs.  The 
age  of  chivalry  really  begins  as  a  prepubertal  period.  For  purposes 
of  convenience  one  may  regard  it  as  embracing  the  years  from  eight 
to  fifteen.  Each  child,  however,  is  a  law  unto  himself,  and  the  spe- 
cific period  of  his  life  that  represents  the  age  of  chivalry  can  only  be 
determined  by  noting  the  physical  and  psychological  development  of 
the  particular  child. 

The  child's  body  is  beginning  to  take  on  new  growth,  the  sexual 
functions  are  beginning  to  expand,  the  emotional  side  is  unfolding  at 
a  very  rapid  pace.  The  actual  expression  of  the  sexual  development 
may  be  marked  by  the  intensification  of  affection  for  the  family. 

The  period  of  civic  awakening  in  turn  marks  a  further  develop- 
ment of  character.  The  child  in  beginning  adolesceaMffla^preciates 
that  he  is  part  of  a  community.  The  world  of  ideS^^HMJanded. 
No  longer  is  the  sharp  focus  on  himself.  His  thou(g;Ht'sjH^^fcs  cen- 
tripetal. There  is  a  realization  of  the  world  outside  '^^Km  home 
and  a  recognition  of  the  fact  that  competition  is  goin^  on  in  it. 

The  awakening  is,  however,  all  designed  to  view  llie  future.  The 
understanding  of  the  relation  of  the  individual  to  the  community  or 
the  state  is  slowly  coming  to  play  a  part  in  the  individual's  life.  How 
wonderful  becomes  the  sense  of  power  on  realizing  that  each  individual 


SEX  HYGIENE   AND   SEX   EDUCATION  553 

is  laden  wilh  responsibility  for  the  health,  morals,  and  progress  of 
many  others !  Not  preservation  of  self  for  self,  but  self-preservation 
to  protect  others,  becomes  a  new  incentive.  The  selfish  idea  in  the 
prevention  of  disease,  physical  or  moral,  takes  on  an  altruistic  aspect. 
Self-happiness  at  last  begins  to  recognize  that  it  includes  and  depends 
upon  the  happiness  of  others. 

Bearing  in  mind  this  artificial  classification,  it  is  obvious 
that  sex  education  is  a  complex  problem  meriting  thorough 
investigation  with  a  view  to  determining  the  scope  of  informa- 
tion to  be  imparted  and  the  methods  for  its  presentation. 

Despite  the  fact  that  sex  education  appears  to  be  an  im- 
perative need,  I  do  not  believe  that  for  many  years  to  come 
it  will  be  regarded  as  a  definite  subject.  Attempts  have  been 
made  to  legislate  it  into  the  school  curriculum,  but  thus  far 
it  has  been  forced  into  only  a  few  high  schools,  and  sufficient 
time  has  not  elapsed  to  judge  of  its  effect.  In  view  of  the 
history  of  compulsory  teaching  as  related  to  alcohol  and  to- 
bacco, it  seems  inadvisable  to  suggest  that  sex  education 
should  be  made  the  basis  of  mandatory  instruction.  It  is 
unwise  to  give  to  the  subject  an  abnormal  position  in  the 
category  of  school  studies.  Dangerous  results  would  surely 
ensue  if  fanatics,  impressed  with  the  importance  of  this  sub- 
ject, should  endeavor  to  compel  its  instruction  in  the  ele- 
mentary schools  previous  to  a  complete  understanding  of  its 
function  there.  Carefully  devised  methods  must  be  thor- 
oughly tested  out  under  normal  conditions.  While  sex  in- 
struction must  be  regarded  as  an  essential  phase  of  educational 
development,  it  must  not  be  viewed  as  a  dominating  force  in 
education  nor  as  a  basic  subject  of  cultural  value  or  of  mental 
development.  Its  highest  significance  lies  within  the  realm 
of  ethifs  and  the  development  of  self-control. 

WhS'  Should  Teach  It? — Recognizing  the  practical  impor- 
tance of  sex  education,  one  immediately  faces  the  question 
as  to  who  should  teach  it.  It  requires  no  special  evidence  to 
prove  that  the  responsibility  for  sex  education  has  been 
shifted  in  turn  upon  the  church,  the  home,  and  the  schools. 


554  EDUCATIONAL  HYGIENE 

In  SO  far  as  the  fundamental  facts  in  sex  education  are  to  be 
acquired  previous  to  school  age,  it  is  manifest  that  the  re- 
sponsibility for  laying  this  foundation  rests  upon  the  home. 
Parents,  however,  have  not  been  keenly  alive  to  the  necessity 
of  this  prehminary  instruction,  nor  do  they  feel  themselves 
particularly  fitted  for  undertaking  the  task.  Parental  timidity 
is  largely  responsible  for  the  sin  of  omission.  Attempts  to 
arouse  parents  through  the  medium  of  the  school  would  un- 
doubtedly awaken  their  consciences  so  that  they  would  re- 
spond to  the  appeal  to  give  the  necessary  facts  along  the 
lines  suggested  by  capable  teachers.  Parents  are  particularly 
capable  of  giving  natural  instruction,  once  they  appreciate 
their  opportunities  for  such  instruction  in  view  of  their  famil- 
iarity with  the  vocabulary  of  their  children,  their  companions, 
and  their  general  experiences. 

In  the  school  itself  the  difficulties  of  giving  sex  education 
arc  multipHed  by  virtue  of  the  size  of  classes,  the  mixture  of 
nationalities,  the  variations  in  age,  and  the  diversity  of  sex 
experience.  Coupled  with  these  difficulties  are  the  lack  of 
training  among  teachers  and  their  consequent  reluctance  to 
impart  sex  instruction. 

The  Training  of  Teachers. — A  great  problem  arises  as 
to  which  teacher  should  give  instruction,  particularly  view- 
ing sex  education  as  a  specific  subject.  There  should  be  no 
specific  teaching  of  sex  education  below  the  seventh  grade 
in  the  elementary  schools.  The  great  problem,  therefore,  is 
to  train  all  grade  teachers  as  to  the  methods  of  imparting 
the  general  sex  content  of  all  the  subjects  in  the  curriculum 
in  a  norm.al  and  constructive  manner  without  making  it  ap- 
pear that  any  unusual  topic  is  being  discussed.  To  achieve 
this  end,  some  training-schools  for  teachers  are  engaged  in 
developing  courses  for  teachers  that  will  give  to  them  the 
broad  vision  necessary  for  understanding  the  place  of  sex 
education  in  the  public  schools  and  will  acquaint  them  with 
the  facts  which  should  be  developed  from  the  general  subject- 
matter  and  the  methods  of  presenting  them  to  the  pupils. 


SEX   HYGIENE   AND    SEX   EDUCATION  555 

In  the  higher  classes  where  departmental  systems  exist,  or 
in  the  high  schools  where  children  are  at  puberty  or  in  adoles- 
cence, there  is  a  more  general  effort  to  devise  definite  lectures 
upon  specific  sex  themes  of  informational  value  and  moral 
force.  Various  teachers  claim  that  the  best  instructors  are 
the  directors  of  physical  training,  or  the  biologists,  or  the 
teachers  of  nature-study,  or  the  school  physicians  or  school 
nurses.  When  specific  instruction  is  indicated,  the  greatest 
stress  should  be  placed  not  so  much  upon  the  subject  that  is 
taught  as  on  the  characteristics  of  the  instructor.  Tact,  sym- 
pathy, understanding,  and  example  are  of  equal  importance 
to  the  possession  of  the  facts  to  be  imparted.  In  possession 
of  the  knowledge  to  be  disseminated,  a  teacher  of  Latin, 
history,  or  mathematics  might  be  preferred  as  the  definite 
instructor  of  the  specific  problems  related  to  adolescence 
rather  than  a  blunt,  unsympathetic,  or  callous  teacher  in 
biology,  physical  training,  or  medicine.  The  basis  of  selection 
of  a  teacher  in  sex  education  should  include  the  personal 
elements  entering  into  teaching  ability  as  well  as  the  recog- 
nition of  the  general  educational  power  of  the  teacher.  Ob- 
viously, the  teacher  to  whom  is  to  be  intrusted  the  careful 
process  of  sex  education  must  be  possessed  of  a  knowledge  of 
the  matter  to  be  presented,  the  methods  of  presenting  it,  and 
a  broad  comprehension  of  the  relation  of  the  subject  to  human 
effort  and  efiiciency.  He  must  possess  judgment  to  determine 
whether  information  should  be  given  to  individuals  or  to 
groups  and  be  able  to  weigh  the  effects  of  his  instruction. 
Sex  education  must  be  achieved  without  the  development 
of  sex  self-consciousness  and  without  the  stimulation  of  erotic 
ideation. 

Sex  Instruction  in  the  High  School. — Considering  sex  in- 
struction as  one  of  the  factors  in  character  formation,  it  is 
obvious  that  the  place  of  sex  education  in  colleges  scarcely 
requires  consideration  in  this  chapter.  The  position  of  sex 
education  in  the  high  school  appears  to  be  definitely  deter- 
mined.     As  normal  boys  and  girls  have  acquired  a  large 


556  EDUCATIONAL  HYGIENE 

measure  of  their  sex  lore  before  puberty,  the  informational 
character  of  sex  education  in  the  high  schools  must  possess  a 
correctional  bent.  The  vast  amount  of  misinformation  ac- 
quired from  the  streets  and  the  gang — pornographic  literature, 
pathological  booklets,  and  false  interpretations  of  current 
events  as  described  in  the  press — has  made  its  impress  upon 
adolescent  minds.  A  careful  pedagogical  effort  is  necessary 
to  eradicate  or  modify  the  false  impressions  and  to  give  the 
definite  and  accurate  information  that  will  raise  the  plane  of 
sex  information  far  from  its  low  level. 

With  some  limitations,  sex  education  in  the  high  school 
possesses  a  prophylactic  value.  The  young  adolescents,  con- 
scious of  new  physical  sensations  and  emotional  stimuli, 
require  careful  guidance  so  that  the  interpretation  of  their 
physical  and  emotional  development  may  be  sanely  directed 
toward  high  ideals.  The  more  mature  students  in  the  high 
schools,  even  in  the  first  year,  who  perchance  have  drifted 
with  the  current  and  possibly  have  succumbed  to  influences 
dangerous  to  their  physical  and  moral  welfare,  need  to  be 
rescued.  For  them  it  is  essential  to  secure  a  broader  vision 
of  life.  The  facts  pertaining  to  sex  must  be  placed  before 
them  in  a  clean  manner  to  indicate  the  dignity  of  manhood  and 
womanhood  and  to  give  them  an  understanding  of  their  duties 
and  responsibilities  in  the  light  of  their  social  obligations. 
The  possibility  of  developing  character  during  adolescence  so 
as  to  lessen  the  likelihood  of  immorality  demands  the  careful 
instruction  of  high-school  students  in  the  facts  pertaining  to 
sex.  This  is  not  a  difficult  matter  for  a  tactful  instructor, 
inasmuch  as  most  of  the  youths  have  acquired  a  large  share 
of  sex  information,  though  in  terms  of  vulgarity  and  obscenity. 
With  the  development  of  the  social  consciousness  at  puberty, 
it  is  possible  to  mould  character  on  the  basis  of  an  appeal  to 
family  pride  and  social  responsibility.  The  mere  presentation 
of  facts  relating  to  anatomy  and  physiology  will  not  sufiice 
to  produce  the  moralizing  result  to  be  sought.  In  the  high 
schools  it  is  possible  to  give  a  few  definite  lectures,  collating 


SEX   HYGIENE   AND    SEX   EDUCATION  557 

the  facts  previously  imparted  in  a  normal  way  and  dealing 
with  the  definite  sex  problems  surrounding  adolescence. 

The  ethical  lessons  involved  in  sex  education  assume  the 
utmost  importance.  Considered  from  the  standpoint  of  bio- 
logical development,  physical  education,  civics,  and  ethics,  the 
high  school  may  afford  definite  instruction  upon  the  mean- 
ing of  puberty  and  the  relation  of  the  sex  instinct  to  personal 
success  and  physical  health.  The  wider  problems  of  the  re- 
lation of  chastity  to  family  welfare,  eugenics,  and  racial  ad- 
vancement can  be  discussed  without  equivocation,  provided 
that  undue  stress  is  not  placed  upon  the  venereal  diseases 
and  other  pathological  phases  of  the  subject.  To  seek  to 
inspire  fear  and  to  estabhsh  character  upon  this  principle  is 
poor  pedagogy.  The  attempt  must  be  made  constructively 
to  create  the  ideal  and  desire  for  clean  living  and  self-control 
on  the  basis  of  a  positive  knowledge  of  the  essential  values  of 
sex  facts.  The  dangers  of  sex  education  in  the  high  schools 
are  practically  negligible,  provided  that  instruction  is  placed 
upon  a  high  biological,  ethical,  and  social  plane.  Its  function 
is  to  further  the  development  of  social  responsibility  rather 
than  to  elucidate  the  merely  personal  phases  of  sex  prob- 
lems. 

Sex  Instruction  in  Elementary  Schools. — In  elementary 
schools  the  position  of  sex  education  is  different.  It  is  desir- 
able to  present  sex  knowledge  to  children  before  adolescence 
without  drawing  attention  to  the  fact  that  such  instruction 
is  being  given.  The  essential  nature  of  puberty  may  be 
appreciated  before  this  physiological  epoch  is  reached.  It 
is  necessary  to  consider  each  school  system  as  a  unit  in  order 
to  determine  in  which  grades  sex  instruction  should  be  given 
and  to  what  extent  and  in  what  manner  the  facts  should  be 
imparted.  The  variations  in  classes  due  to  numbers,  differ- 
ences in  age,  nationality,  and  sex  precocity  increase  the  diffi- 
culties of  definite  sex  education  even  in  the  upper  grades  of 
the  elementary  schools.  If,  however,  sex  education  is  re- 
garded as  essential  to  the  welfare  of  future  citizens,  it  is  man- 


558  EDUCATIONAL   HYGIENE 

ifestly  important  that  such  education  should  be  given  to  the 
maximum  number  of  children,  and,  since  most  pupils  never 
reach  the  high  schools,  this  becomes  possible  only  through  in- 
struction in  the  elementary  schools.  It  is  possible  to  lay  the 
foundations  of  a  rational  sex  education  in  such  a  manner 
that  elementary-school  children  will  not  leave  the  schools,  as  at 
present,  entirely  ignorant  of  the  great  importance  of  the  sex 
instinct  in  the  affairs  of  the  world. 

Naturally,  in  imparting  special  instruction,  particularly 
for  those  who  are  about  to  leave  school  in  order  to  go  to  work, 
the  sexes  must  be  segregated.  Within  the  sexes,  groupings 
should  be  made  not  so  much  on  the  basis  of  chronological  age 
as  of  psychological  age.  The  differences  in  sex  precocity 
make  it  difficult  for  teachers,  save  those  of  the  wisest  discre- 
tion, to  give  instruction  in  such  a  manner  as  to  preclude  the 
augmentation  of  self-consciousness. 

The  barriers  of  modesty  and  shame,  having  arisen  in  child 
consciousness  just  before  puberty,  increase  the  difficulties  of 
sex  education  at  this  period  of  school  life  unless  one  recog- 
nizes that  directness  of  speech,  frankness,  and  sympathy  are 
essential  in  order  to  overcome  temporarily  these  barriers 
without  breaking  them  down.  The  proper  grouping  of  chil- 
dren, therefore,  is  imperative.  For  this  purpose  the  advice  of 
all  teachers  must  be  secured  even  though  the  instruction  be 
given  by  one  teacher.  Frequently  it  is  advisable  to  omit 
from  the  group  some  children  whose  morals  are  believed  to 
be  impaired  in  order  to  give  them  individual  attention  that 
their  instruction  may  be  gauged  according  to  their  experiences 
and  needs. 

Individualized  sex  instruction,  while  theoretically  desir- 
able at  times,  is  practically  impossible  in  a  public-school 
system,  save  in  connection  with  problems  of  discipline  or  in 
response  to  requests  from  parents  for  the  imparting  of  such 
individual  instruction.  The  disadvantage  of  individual  in- 
struction as  opposed  to  group  instruction  is  that  it  may  tend 
to  accentuate  the  peculiar  qualities  of  the  instruction  given, 


SEX   HYGIENE   AND    SEX   EDUCATION  559 

whereas  the  group  instruction  makes  it  appear  to  be  a  normal 
part  of  education  to  be  received  by  all  and  does  not  serve  to 
build  up  an  overweening  false  modesty. 

All  steps  leading  to  the  introduction  to  sex  education  must 
be  taken  slowly  in  order  that  public  opinion  may  constantly 
support  the  movement.  The  conservative  position  of  the 
puolic  is  perfectly  natural,  particularly  in  the  light  of  the  op- 
position of  teachers  toward  the  introduction  of  this  subject. 
Of  primal  importance  is  the  education  of  the  public  as  to  the 
meaning  of  sex  education,  the  necessity  for  its  introduction 
into  the  schools,  and  the  educational  methods  utilized  by 
teachers.  Secottd,  it  is  a  \dtal  necessity  that  teachers  be  given 
a  proper  understanding  of  the  purposes  of  sex  education  and 
receive  training  in  the  matter  and  methods  essential  for  the 
proper  teaching  of  the  subject.  Third,  training-schools  for 
teachers  must  organize  definite  courses  for  the  adequate 
training  of  those  who  appear  to  possess  special  fitness  for 
the  presentation  of  the  facts  relating  to  sex  problems.  Such 
courses  naturally  must  be  developed  on  the  basis  of  biology, 
natural  sciences,  physiology,  anatomy,  hygiene,  zoology,  and 
ethics.  The  greatest  need  at  the  present  time  is  the  prepara- 
tion of  teachers  of  this  subject.  It  has  been  urged  by  some 
that  sex  instruction  by  any  type  of  teacher  would  be  prefer- 
able to  the  present  system  of  educational  neglect.  Wliile 
there  may  be  some  merit  in  this  argument,  it  loses  sight  of  the 
fact  that  improper  pedagogical  methods  may  do  incalculable 
damage  by  destroying  modesty,  lessening  shame,  inspiring 
fear,  and  stimulating  erotic  desire. 

Dangers. — The  dangers  of  early  instruction  in  sex  facts 
may  arise  from: 

(i)  The  Accentuation  of  Pathology. — To  focus  all  atten- 
tion upon  the  venereal  diseases  and  the  resultant  personal  or 
social  damage  is  to  build  up  a  morbid  spirit  and  develop  a 
phobia  or  encourage  an  obsession  leading  to  various  nervous 
phenomena  prejudicial  to  mental  balance,  physical  health, 
and  moral  stability.     The  morbid  phases  of  sex  should  be 


560  EDUCATIONAL  HYGIENE 

relegated  to  the  background  and  introduced  as  secondary 
phases  of  sex  education.  This  is  possible  without  any  sacri- 
fice of  the  content  of  the  subject  and  with  distinct  advantage 
in  its  effect  upon  mind  and  character. 

(2)  The  Stimulation  of  the  Sex  Instinct. — The  method  of 
imparting  instruction  should  be  totally  impersonal.  Facts 
should  be  presented  in  their  widest  relations  without  making 
it  appear  that  any  particular  individual  is  being  considered 
in  the  discussion.  The  sex  instinct  should  be  presented  as  a 
normal  part  of  child  nature  with  attributes  that  lead  to  the 
development  of  manliness  and  womanliness  and  that  stand 
for  the  higher  virtues.  The  sex  instinct  should  not  be  referred 
to  as  a  purely  physical  phenomenon  whose  main  purpose  is 
simply  reproduction.  All  references  to  the  physiology  of 
sex  may  be  interpreted  in  terms  of  social  function  rather  than 
personal  function.  Scientific  terms  should  be  used  wherever 
necessary,  and  all  descriptions  of  processes  should  be  given  in 
plain  terms  similar  to  those  employed  in  teaching  botany 
and  zoology.  By  keeping  the  discussions  on  the  plane  of 
biology  and  universal  facts,  the  likelihood  of  stimulating  the 
sexual  instinct  is  decreased. 

(3)  The  Stimulation  of  a  Morbid  Imagination. — By  unfold- 
ing all  the  mysteries  of  life  in  a  sympathetic  and  dispassionate 
manner,  all  the  facts  pertaining  to  sex  development  are  re- 
vealed. The  imagination  must  not  be  appealed  to,  nor  should 
there  be  any  hesitancy  on  the  part  of  the  teacher  in  the  ex- 
position of  facts  that  will  permit  an  appeal  to  imagination. 
Descriptions,  details  of  processes,  expositions,  and  reasoning 
should  be  sufficiently  complete,  direct,  and  impersonal  to  allow 
no  room  for  imaginative  processes.  The  present  need  for 
frank  sex  instruction  is  largely  due  to  the  fact  that  the  erotic 
imagination  of  children  receives  no  conscious  check  but  is 
constantly  stimulated  through  their  inability  to  clear  up  the 
magnified  mysteries. 

(4)  The  Development  of  Self -Consciousness. — Tactless  in- 
struction, with  personal  reminiscences,  or  the  direct  considera- 


SEX   HYGIENE   AND    SEX   EDUCATION  56 1 

tion  of  personal  problems  in  the  group,  tends  to  develop  self- 
consciousness.  This  is  an  undesirable  method  and  creates 
hostility  on  the  part  of  children  struggling  with  their  own 
emotions  and  unable  to  consider  the  sex  facts  save  in  terms 
of  their  own  personality.  At  times  it  may  create  unnecessary 
fears  and  lessen  self-confidence,  create  a  feehng  of  self-de- 
preciation, and  tend  to  offset  the  upbuilding  value  of  the  in- 
struction imparted. 

(5)  The  Breaking  Down  of  Sex  Barriers. — Among  the  nor- 
mal protective  devices  are  certain  psychological  barriers, 
such  as  modesty  and  shame.  No  instruction  should  be  given 
which  would  tend  to  undermine  the  force  of  these  barriers. 
A  vast  distinction  must  be  made  between  false  modesty  and 
false  shame  and  the  more  substantial  psychological  attributes. 
To  decrease  modesty  or  belittle  shame  is  to  destroy  valuable 
factors  in  conserving  or  upbuilding  strong  morals.  The  pres- 
entation of  the  facts  relating  to  sex  phenomena  must  there- 
fore take  into  consideration  these  barriers  with  a  view  to 
strengthening  them  instead  of  undermining  them. 

(6)  The  Encouragement  of  Sex  Conversations. — Obviously, 
at  the  present  time  matters  pertaining  to  sex  constitute  no 
small  part  of  the  general  themes  of  conversation  of  boys  and 
girls  at  school.  By  destroying  the  secret  nature  of  sex 
themes  there  is  a  tendency  to  decrease  the  importance  of  such 
topics  of  conversation.  There  would  probably  be  less  harm 
in  conversations  dealing  with  sex  matters  were  they  founded 
upon  proper  information  and  ideals  than  under  the  present 
system  of  vulgarity,  imaginativeness,  and  secrecy.  At  the 
same  time,  every  conscious  effort  should  be  made  to  decrease 
discussions  of  sex  themes  based  upon  misinformation,  ob- 
scenity, indecency,  and  licentiousness. 

(7)  The  Creation  of  Curiosity. — There  can  be  no  question 
that  curiosity  is  a  normal  attribute  existing  with  undue  force 
as  related  to  sexual  matters.  A  rational  exposition  of  the 
problems  of  sex  tends  to  allay  curiosity  and  not  to  stimulate 
it.     The  creation  of  stronger  self-control,  founded  upon  basic 


562  EDUCATIONAL  HYGIENE 

knowledge,  serves  to  relieve  the  pressure  of  curiosity  and 
affords  a  valuable  safeguard  against  its  overdevelopment. 
Careful  teaching  will  not  create  an  abnormal  interest  in  the 
subject,  but  it  will  simply  serve  to  guide  and  direct  the 
normal  and  basic  interest  with  an  array  of  facts  and  reasons 
which  enables  it  to  be  satisfied  far  better  than  under  the 
present  system  where  interest  is  forced  by  secrecy,  gang  in- 
fluence, and  vicious  literature.  Eroticism  becomes  subordi- 
nated to  a  healthful  interest  and  a  conscious  appreciation  of 
the  meaning  of  sex  in  relation  to  life. 

Methods. — The  method  of  instruction  in  matters  pertain- 
ing to  sex  is  practically  to  impart  such  knowledge  of  sex  at 
each  period  of  child  life  as  may  be  valuable  and  necessary  for 
preserving  health,  developing  high  planes  of  thought,  and 
controlling  conduct.  Recognizing  the  fundamental  facts  es- 
sential for  the  health  and  morality  of  the  community,  it  seeks 
to  build  up  normal  human  beings  of  high  ideals  and  good 
moral  character  with  the  fundamental  facts  enabling  them  to 
make  an  intelligent  choice  as  to  action.  The  point  of  departure 
in  instruction  must  be  the  normality  of  sex  life  and  the  nor- 
mality of  the  sex  instinct.  The  problems  of  pathology  are 
of  secondary  importance.  Anatomy  should  be  dwelt  upon 
as  little  as  possible  and  embryology  should  be  involved  only 
in  so  far  as  may  be  necessary  for  the  interpretation  of  the  re- 
productive phenomena  in  all  the  plant  and  animal  kingdom. 
The  scientific  processes  are  to  be  found  in  the  biological  in- 
terpretation of  nature-study,  supplemented  by  the  values  to 
be  gotten  from  physical  education,  civics,  hygiene,  history, 
and  ethics. 

In  methods  of  instruction  there  is  a  positive  phase  which 
has  to  do  with  the  development  of  the  child  and  a  negative 
phase  which  deals  with  the  child's  environment.  It  is  ob- 
viously impossible  for  a  school  to  control  a  child's  environ- 
ment, nor  is  it  within  the  bounds  of  possibihty  to  safeguard 
children  from  all  contacts  with  demorahzing  and  corrupting 
influences  in  their  environment.     Instruction  as  to  the  im- 


SEX   HYGIENE  AND    SEX   EDUCATION  5O3 

portance  of  bathing,  correct  methods  of  clothing,  the  values 
of  physical  exercises,  athletics,  and  recreations  of  a  whole- 
some character,  is  within  the  limits  of  sex  instruction  in  so 
far  as  it  is  related  to  environment.  Guidance  as  to  theatres, 
gambling,  alcoholism,  debasing  associates  in  the  gang,  the 
advantages  of  playgrounds,  parks,  libraries,  the  importance 
of  religion,  the  necessity  of  cherishing  home  life  and  maintain- 
ing confidences  with  parents,  properly  may  be  included  in  a 
constructive  programme  of  sex  education  involving  the  en- 
vironment of  children. 

In  the  positive  education  of  the  child,  character  formation 
is  the  ultimate  aim.  Ia_lli£_study  of  Reproduction  ^dujing 
the  ^dolescent_period,  utilizing  the  facts  to  be  gleaned. from 
biology,,  the  ethical_implications  require  greatest  emphasis. 
The  evolution  of  human  lovePtEeTeTations  of  pareiitliQpd 


family  welfare,  and'THe- nature  and  importance  ofme  home, 
together  with  the  ethical  relations  which  should  exist  between 
parents  and  children,  are  ethical  and  biological  concepis^pf 
exceedingly  great  value  in  making  appeals  to  adolesceftts. 

Gradual  Development. — The  entire  subject-matter  of  sex 
education  must  be  developed  gradually.  The  subject  must 
be  evolved.  The  spontaneous  exposition  of  the  great  truths 
must  not  be  permitted.  Sex  education  must  cover  a  long 
period  of  years  and  one  step  should  be  based  upon  pre- 
vious educational  supports.  The  study  of  reproduction  in 
plants  and  animals  covers  a  period  of  years  in  teaching  and, 
when  based  upon  familiar  plants  and  animals,  affords  abun- 
dant facts  for  indicating  the  analogies  in  human  life.  The 
purposes  of  sex  education  are  not  merely  to  be  informational 
in  character  but  to  yield  sufficient  material  for  character 
training.  Mere  facts  in  themselves  present  few  motives 
for  conduct.  The  trend  of  sex  education  must  therefore  be 
in  the  direction  of  creating  definite  high  motives  of  altruistic 
character.  Obviously,  the  form  of  instruction  given  in  night- 
schools  to  adults  may  consist  of  a  broader  treatment  of  the 
human   aspects  of   sex  problems.     Among   the  adolescents, 


564  EDUCATIONAL  HYGIENE 

however,  the  inspiration  of  high  ideals  of  sex  conduct  must 
form  the  end  and  aim  of  the  instruction. 

Judgment,  tact,  sympathy,  and  understanding  are  req- 
uisite in  order  properly  to  balance  the  biological  facts  with 
the  ethical  concepts  so  that  instruction  may  not  appear  to  be 
preachment,  and  so  that  the  basic  facts  may  be  presented  be- 
fore the  essential  temptations  of  youth  have  begun  to  assail 
the  child  mind. 

The  use  of  charts  and  illustrations  merits  careful  con- 
sideration in  order  that  they  may  not  present  more  material 
than  the  child  can  assimilate  in  connection  with  the  particular 
subject  under  discussion.  The  use  of  books  relating  to  sex 
education  by  the  children  is  to  be  deprecated  until  adoles- 
cence is  well  advanced.  The  value  of  sex  education  is  en- 
hanced through  giving  adequate  information  without  creating 
an  inordinate  interest  or  awakening  an  abnormal  curiosity  as 
to  numerous  questions,  such  as  would  naturally  be  developed 
through  the  employment  of  books  which  cannot  be  adapted 
in  scope  or  method  of  presentation  to  fit  large  groups  of  chil- 
dren in  the  preadolescent  stage. 

Without  going  into  details  as  to  the  great  number  and 
variety  of  facts  to  be  imparted,  I  may  repeat  that  the  con- 
notations of  Hterature,  history,  and  civics  must  be  combined 
with  the  facts  of  biology,  nature-study,  and  hygiene  and. in- 
terpreted in  terms  of  ethics  and  sociology.  During  the  early 
ages,  sex  facts  must  be  intellectuahzed  in  order  not  to  empha- 
size the  developing  emotional  phases  of  child  nature.  During 
pubertv,_when  emotional  waves  are  fast  rushing  upon  the 
child  mind7the}rnmsF5eliar^  and~Hirected  mto  channels^ 
thaTwiir^o  the  most  good  and  least  damage.  The  physical 
phases  of  sex  problems  should  not  be  stressed  for  adolescents 
except  in  so  far  as  they  are  spiritualized.  The  intellectual 
appreciation  of  the  facts  presented  merely  furnishes  the  basis 
of  educating  the  emotions.  The  normal  development  of  sex 
themes  proceeds  in  three  stages:  first,  the  intellectual  ac- 
quisition of  facts;  second,  the  interpretation  of  emotional  life; 


SEX  HYGIENE  AND   SEX  EDUCATION  565 

third,  the  spiritualizing  of  sex  consciousness.  These  three 
stages  are  not  totally  dissociated  at  any  period  of  child  devel- 
opment but  must  be  most  closely  interwoven  in  the  instruc- 
tion during  adolescence  and  thereafter. 

Education  of  Parents  and  Public  Opinion. — There  are 
frequently  times  during  elementary-school  periods  when  spe- 
cial problems  arise  requiring  specific  instruction  to  be  given 
to  individual  children.  This  must  be  done  frankly  and  hon- 
estly, whether  it  deals  with  masturbation  or  gross  immo- 
rality. The  frank  discussion  of  topics  involved  in  school 
discipline  carries  with  it  the  obligation  to  discuss  them  also 
with  parents  in  order  to  secure  the  most  effective  results. 
While  parents  represent  the  persons  upon  whom  rests  the 
responsibility  for  sex  education,  the  school  cannot  ignore  the 
fact  that  parents  are  ignorant  of  the  best  methods  of  peda- 
gogical procedure.  For  this  reason  it  is  highly  desirable  that 
schools,  through  the  medium  of  mothers'  clubs,  parents'  as- 
sociations, or  general  public  lectures,  should  afiford  an  oppor- 
tunity to  parents  to  receive  instruction  upon  the  necessities 
of  sex  education,  together  with  pedagogical  methods  and  the 
material  required  at  different  ages  of  child  development. 
Particular  advantage  accrues  from  giving  the  instruction  to 
mothers  in  connection  with  the  clubs  of  kindergarten  mothers 
during  the  first  year  of  the  child's  attendance  at  school. 
Herein  is  a  wide  field  of  usefulness  of  the  elementary  school, 
bringing  the  school  and  home  in  closer  co-operation  and 
harmony  in  the  interests  of  sex  education  of  the  young. 

In  the  broad  problem  of  developing  a  rational  public 
opinion  that  will  countenance  the  freer  discussion  of  the 
serious  hygienic  and  moral  dangers  involved  in  the  present 
attitude  of  indifference  or  neglect,  the  school  has  a  tremen- 
dous responsibility.  Under  school  auspices  parents  may  be 
educated  to  higher  ideals  and  to  a  more  healthful  apprecia- 
tion of  the  importance  of  conveying  to  the  young  a  knowledge 
of  the  sacredness  of  human  development.  The  school  can 
indicate  the  sociological  importance  of  sex  morality.    In  ad- 


566  EDUCATIONAL   HYGIENE 

dition  to  this,  the  school  will  foster  a  broader  concept  as  to 
the  ethical  import  of  sex  education  and  its  relation  to  the 
welfare  of  future  generations.  This  may  all  be  given  con- 
structively without  emphasizing  pathology. 

The  Need  for  Trained  Teachers. — The  crying  need  of  the 
present  time  is  the  training  of  capable  teachers  in  this  line 
of  educational  endeavor.  Training-schools  must  adjust  their 
courses  to  the  future  needs  of  the  community.  The  process 
of  introducing  sex  education  into  the  pubhc-school  system 
should  proceed  slowly  and  advance  no  more  rapidly  than  the 
education  of  teachers.  This  does  not  mean  the  creation  of  a 
new  set  of  specialists  in  sex  themes.  It  involves  merely  im- 
parting an  accurate  knowledge  of  the  essential  biologic  facts, 
together  with  the  inculcation  of  tact,  understanding,  and  skill 
in  presenting  the  facts  in  a  sympathetic  manner  that  will 
make  an  impress  upon  the  minds  of  children  in  the  course  of 
ordinary  instruction.  For  the  presentation  of  specific  themes 
in  sex  instruction  broad  vision  is  essential,  with  a  clear  un- 
derstanding of  the  psychology  of  sex,  together  with  the  varia- 
tions in  child  psychology  according  to  the  degree  of  physical, 
mental,  and  moral  development. 

Conclusion. — Thus  it  is  patent  that  the  educational  aims 
of  sex  instruction  are  to  supply  adequate  information  to  serve 
as  the  basis  of  conscious  reasoning  with  a  view  to  stimulating 
the  will  to  more  effective  self-control.  Modesty,  chastity, 
courage,  pride,  honor,  and  self-control  are  normal  ends. 
One  seeks  to  subordinate  self-assertion  in  individualism  by 
the  development  of  social  responsibility  and  a  willingness  to 
submit  to  self-disciphne.  The  function  of  sex  education  is  to 
preserve  health,  develop  right  thinking,  and  control  conduct. 
Its  educational  values  are  biological,  physiological,  psycho- 
logical, hygienic,  and  pedagogical.  Sex  education  should  de- 
termine the  evolution  of  sex  character  on  the  basis  of  the  di- 
rection and  control  of  sex  characteristics. 


V.    THE  HYGIENE  OF  INSTRUCTION 

CHAPTER  XXX 
THE  GENERAL  HYGIENE  OF  INSTRUCTION 

The  Problem. — In  its  application  to  the  instruction  of 
children,  hygiene  takes  on  a  wider  significance,  if  possible, 
than  it  does  in  any  of  its  other  special  phases.  In  looking  to 
prevention  of  immediate  physical  injury  it  is  negative,  in 
its  care  for  future  physical  development  it  is  positive  in  its 
view-point;  but  in  addition  it  must  concern  itself  with  sim- 
ilar problems,  negative  and  positive,  with  regard  to  mental 
health  and  development.  It  must  study  both  the  objective 
and  the  subjective  results  of  school  life.  Therefore,  while 
busied  with  the  problem  of  providing  conditions  that  make 
for  such  characteristics  as  strong  muscles,  deep  breathing, 
erect  posture,  and  clear  vision,  it  must  have  an  "ear  to  the 
ground,"  so  to  speak,  for  any  condition  that  may  lead  to  faulty 
habits  of  attention  and  association,  hinder  the  development 
of  good  memory,  or  in  any  way  interfere  with  the  develop- 
ment or  cultivation  of  the  power  to  think  clearly.  Even  the 
emotions  must  be  considered,  so  that  it  devolves  upon  hygiene 
to  consider  the  attitudes,  healthful  and  otherwise,  that  are 
related  to  or  that  result  from  the  child's  experience  in  school. 
It  is  this  broad,  or,  if  you  please,  this  multiple,  view-point 
that  determines  what  are  the  problems  and  what  the  methods 
of  their  solution  in  the  hygiene  of  instruction,  or,  as  it  is 
termed  by  the  editor,  the  hygiene  of  methods  of  teaching  and 
management. 

It  has  been  pointed  out  that  our  army  of  school-children 
in  this  country  is  now  some  eighteen  to  twenty  millions  strong 
and  that  throughout  the  greater  part  of  the  year  about  half 
the  waking  time  of  these  young  recruits  is  spent  in  school. 

567 


568  EDUCATIONAL  HYGIENE 

They  are  there  to  receive  instruction.  It  is  for  the  same 
purpose  that  teachers  are  hired  and  that  buildings  and 
grounds  are  provided  and  equipped  and  maintained  in  every 
State. 

Now,  the  fundamental  principle  of  instruction  is  that  the 
organism  of  the  child  is  immature,  is  still  developing,  and 
that  by  imposing  certain  conditions  we  are  able  to  influence, 
to  modify,  and  to  mould  his  physical  and  mental  development. 
Instruction,  therefore,  touches  his  life  at  its  most  vital  points. 

But  let  us  not  forget  that  the  child's  response  to  bad  may 
be  as  ready  as  that  to  good  instruction.  Bad  environment  or 
faulty  methods  may  initiate  abnormalities  of  development. 
This  is  especially  true  of  the  mental  development  of  children 
who  have  inherited  or  acquired  tendencies  toward  neuroses. 

In  the  Hght  of  such  facts,  the  importance  of  making  the 
instruction  of  this  army  of  future  citizens  hygienic  looms 
large  beyond  our  powers  of  comprehension.  We  are  intro- 
duced here  to  problems  that  reach  nation-wide  and  soul-deep. 
They  are  of  vital  importance  to  the  domestic  happiness  and 
the  prosperity  of  millions  of  future  homes,  and  they  relate 
themselves  to  a  great  extent  to  the  economic  welfare  of  every 
State. 

Instruction  is  a  general  term  and  may  be  concerned  with 
a  wide  range  of  activities,  physical,  mental,  or  both.  A 
rigid  classification  and  detailed  treatment  of  these  is  out  of 
the  question  here;  I  shall  therefore  only  attempt  to  summar- 
ize the  more  important  principles  involved  and  give  some  of 
their  applications,  taking  up  first  those  of  a  more  general 
nature  and  following  with  those  that  concern  themselves 
more  particularly  with  mental  hygiene.  It  should  be  stated 
that  in  doing  this  I  draw  heavily  from  both  published  and 
unpublished  material  of  Doctor  Wm.  H.  Burnham,  of  Clark 
University,  as  well  as  from  notes  taken  in  his  courses  of 
lectures.  Indeed,  those  paragraphs  which  deal  more  specific- 
ally with  the  characteristics  of  mental  health  do  little  more 
than  to  summarize  his  contributions  in  this  field. 


THE   GENERAL  HYGIENE   OE   INSTRUCTION  569 

General   Hygiene 

Innate  Ability. — Extended  investigations  have  clearly  de- 
monstrated that  children  are  not  all  equal  with  respect  to 
their  abilities  along  certain  lines.  Especially  is  this  true  in 
case  of  those  mental  powers  upon  which  so  much  of  the  or- 
dinary school  instruction  depends.  Hygiene  of  instruction 
demands  that  this  be  recognized  and  that  requirements  be 
adapted  to  the  abilities  and  individualities  of  the  children. 

Some  children  are  mentally  defective;  they  should  be 
placed  at  once  in  special  classes  and  receive  special  instruc- 
tion by  special  methods.  Some  are  merely  slow  in  their 
development,  constituting  the  type  known  as  ''retarded"; 
these,  too,  should  be  placed  in  special  classes  and  given  indi- 
vidual attention.  With  a  little  care  they  can,  without  injury, 
be  brought  up  to  the  average,  in  course  of  time.  On  the 
other  hand,  to  attempt  to  drive  such  pupils  through  their 
classes  at  the  same  pace  and  in  company  with  their  more 
developed  comrades  of  equal  age  is  in  many  cases  merely  to 
transform  retardation  into  arrest. 

Again,  many  a  child  is  so  unfortunate  as  to  have  inherited 
an  unstable  nervous  system  and  thus  have  within  him  a  strong 
tendency  toward  the  development  of  some  form  of  neurosis. 
Usually  this  is  shown  by  such  characteristics  as  nervousness, 
inability  to  sit  still,  and  lack  of  motor  control.  Hygiene  would 
demand  that  in  such  cases  special  care  be  taken  to  avoid 
overstrain  from  heavy  work  and  that  no  tasks  be  given  de- 
manding strained  attention  for  lengthy  periods.  Better  to 
modify  the  instruction  than  to  run  the  risk  of  throwing  the 
nervous  organization  out  of  balance,  perhaps  for  life. 

Similarly,  the  unusually  gifted  pupil  should  receive  some 
special  consideration.  Holding  such  a  pupil  to  constant  repe- 
tition of  well-known  and  easy  tasks  that  require  no  effort  may 
lead  to  loss  of  interest,  inattention,  dawdling,  and  even  fail- 
ure. An  otherwise  specially  promising  pupil  is  thus  trans- 
formed into  a  repeater  and  a  dullard. 


57©  EDUCATIONAL   HYGIENE 

Stage  of  Development. — The  fitting  of  instruction  to  the 
stage  of  the  child's  development,  physical  and  mental,  is  of 
significance  for  hygiene. 

Length  of  life  cannot  be  depended  upon  as  a  measure  of 
the  advancement  a  child  has  made  in  his  development.  Girls 
are  some  two  years  ahead  of  boys  in  their  development  at 
the  time  of  puberty,  and  progress  more  rapidly  to  maturity. 
Even  among  children  of  the  same  sex,  variations  are  great. 
Phenomena  of  growth,  pubescence,  skeletal  ossification,  den- 
tition— all  these  give  evidence  that  the  rapidity  with  which 
children  approach  maturity  varies  widely  from  individual  to 
individual.  The  degree  of  relationship  between  these  and  the 
development  of  mental  power  has  not  been  entirely  worked 
out.  A  correlation  is  suggested,  however,  by  such  investiga- 
tions as  those  of  Porter,  Smedley,  and  Crampton,  in  America, 
and  of  Grazianoff ,  Sack,  Quirsfeld,  and  Riez,  in  Germany,  all  of 
whom  found  a  close  relationship  between  various  phases  of 
physical  health  and  development  on  the  one  hand  and  either 
school  success  or  mental  power  on  the  other. 

As  has  often  been  pointed  out,  it  is  clear  that  there  is  a 
pedagogical  and  hygienic  moral  to  be  drawn  from  these  facts, 
namely,  that  grading  for  educational  or  other  purposes  on  the 
basis  of  chronological  age,  i.  e.,  age  in  years  alone,  is  en- 
tirely inadequate.  Doctor  Crampton  has  demonstrated  how 
true  this  is  for  pubescent  boys.  We  may  therefore  state  as  a 
hygienic  principle  that  grading,  implying,  as  it  does,  a  measure- 
ment of  the  amount  and  kind  of  work  that  may  properly  be 
required  of  a  pupil,  should  be  based  upon  the  mental  and 
physical  powers  to  which  he  has  attained  at  a  given  stage  of 
development,  regardless  of  what  his  age  in  years  may  be. 

This  principle  becomes  especially  significant  when  applied 
to  school  beginners.  As  I  have  shown  elsewhere,  there  is 
much  evidence  in  support  of  the  theory  that  a  transition  or 
"nodality"  in  general  de\elopmcnt  occurs  at  about  this  time. 
This  is  indicated  by  a  number  of  phenomena,  such  as  varia- 
tions in  growth,  second  dentition,  change  of  growth  rate  in 


THE   GENERAL   HYGIENE   OF   INSTRUCTION  57 1 

certain  organs,  and  acquisitions  of  certain  neuro-muscular 
and  psychical  powers.  These  do  not  occur  in  all  children 
at  a  given  age.  Variations  are  great,  as  is  well  illustrated  by 
skeletal  ossification  and  by  dentition. 

The  exact  relationship  of  these  phenomena  to  each  other 
and  to  general  development  is  not  known,  much  less  their 
relationship  to  mentahty.  But,  however  that  may  be,  the 
fact  that  so  many  fundamental  developmental  changes  occur 
at  this  period  of  life  is  sufficient  basis  for  the  demand  that, 
until  it  is  past,  any  instruction  other  than  that  partaking  of 
the  nature  of  free  play  and  allowing  for  natural  reactions  and 
normal  physical  development  should  probably  not  be  given. 
The  hygiene  of  instruction  up  to  the  age  of  seven  or  eight 
years  is  distinctly  the  hygiene  of  general  health  and  normal 
development.  Moreover,  there  are  many  indications  that 
those  children  who  do  not  begin  formal  school  work  until 
about  the  eighth  year  are  not  only  not  handicapped  but  are 
rather  benefited  thereby  in  the  long  run.  The  interesting 
and  accumulating  data  concerning  certain  precocious  children 
who  at  a  very  early  age  gained  remarkable  command  of  cer- 
tain forms  of  school  knowledge  have  seemed  to  some  to  point 
in  the  opposite  direction,  but  this  is  doubtful,  to  say  the  least. 

So  much  for  the  general  statement.  But,  again,  the  above 
facts  justify  the  demand  that  when  the  time  for  school  work 
does  arrive,  entrance  be  based  not  upon  the  mere  age  in  years, 
but  upon  the  degree  of  physical  and  mental  development. 

We  hear  much  in  these  days  about  "repeaters."  And 
truly  our  instruction  is  not  hygienic  when  we  have  a  high 
percentage  of  pupils  in  all  our  schools  droning  over  again  the 
work  of  last  year.  But,  bearing  in  mind  the  great  variation 
in  development  at  this  period,  and  also  the  general  relation- 
ship between  physical  and  mental  development,  it  must  follow 
that  very  many  of  the  problems  of  "repeaters"  in  the  grades 
would  never  be  met  if  children  were  admitted  to  the  first 
grades  only  on  the  basis  of  their  fitness  as  indicated  by  stage 
of  development. 


572  EDUCATIONAL  HYGIENE  "    *  ' 

Properly,  grading  should  take  into  consideration  at  least 
those  special  phases  of  development  that  have  been  mentioned 
and  possibly  some  others  also.  It  must  be  admitted  that  no 
standards  for  such  grading  have  been  established.  In  view  of 
their  absence,  and  also  in  view  of  the  fact  that  dentition  is 
so  closely  related  to  development  as  a  whole  and  to  nutrition 
in  particular,  there  is  much  to  be  said  in  favor  of  taking  that 
as  an  index.  Unless  otherwise  exceptionally  well  developed, 
there  is,  hygienically,  some  question  as  to  whether  a  child 
who  has  not  erupted  his  first  permanent  molars  should  begin 
formal  school  work. 

Differences  in  the  development  of  the  sexes  must  be 
considered.  At  the  period  of  life  when  school  work  is  usually 
begun,  girls  are  relatively  more  advanced  than  boys  of  equal 
age.  The  difference  between  them  grows  progressively 
greater  up  to  the  time  of  maturity,  being  especially  significant 
during  the  pubertal  years.  This  being  true,  the  question  is 
raised  as  to  whether  the  instruction  of  the  sexes  should  be 
the  same  from  the  beginning,  but  sufficient  data  are  not  yet 
available  upon  which  to  base  a  definite  answer.  On  the 
other  hand,  the  difference  between  the  sexes  at  the  pubertal 
period  is  so  evident  and  so  great  that  a  differentiation  of  in- 
struction becomes  not  only  a  hygienic  but  a  pedagogical  de- 
mand also. 

Knowledge  of  mental  development  is  not  sufficiently  ac- 
curate to  admit  of  a  close  grading.  Some  facts  of  a  general 
nature  are  known,  however,  a  few  of  which  relate  themselves 
to  our  topic  and  may  here  be  mentioned. 

Much  of  present-day  classroom  procedure  very  easily 
approximates  a  reaction-time  experiment.  That  is,  the  child 
is  given  a  question  to  which  he  must  reply  in  the  briefest 
possible  time.  This  is  fundamentally  wrong.  It  has  been 
demonstrated  experimentally  that  the  child's  mind  reacts 
much  more  slowly  than  that  of  the  adult,  as  shown  by  the 
greater  length  of  time  it  takes  him  to  make  associations  of 
ideas.     Quick   replies   should   therefore   be   neither   required 


THE   GENERAL  HYGIENE   OF   INSTRUCTION  573 

nor  expected  from  young  children,  especially  when  the  ma- 
terial with  which  they  deal  is  new  and  unfamihar  or  difficult. 

Questions  should  be  clearly  and  definitely  stated,  and  then 
a  reasonable  time  for  answer  should  be  given,  with  some  re- 
gard, of  course,  for  individual  differences  of  pupils.  Driving 
the  child  to  answer  too  rapidly  is  liable  to  result  in  habits  of 
carelessness  and  inaccuracy,  establishment  of  wrong  reac- 
tions that  may  persist  and  impede  thinking  in  the  future, 
discouragement  on  account  of  failure,  nervousness,  and  over- 
strain, or  a  combination  of  these.  In  any  case,  the  result  is 
liable  to  be  detrimental  to  development  of  clear  thinking 
and  good  mental  power.  In  the  early  school  years,  drill  for 
speed  should  only  follow  the  mastery  of  the  proper  associations. 
When  proper  associations  are  firmly  established,  drill  for  speed 
is  in  place. 

Again,  the  mental  imagery  of  the  child  up  to  about  the 
pubertal  period  is  concrete  rather  than  abstract.  This  is 
the  normal  condition;  and  instruction,  to  be  hygienic,  should 
take  account  of  the  fact.  Power  of  abstract  reasoning  de- 
velops late — at  least  as  late  as  the  adolescent  years.  Stimu- 
lation to  this  kind  of  activity  at  too  early  an  age  is  liable  to 
cause  premature  development  or  overstrain,  either  of  which 
is  injurious  and  should  be  guarded  against. 

Doctor  Hall's  early  investigation  showed  that  a  high  per- 
centage of  children  begin  school  remarkably  poor  in  ideas 
gained  from  experience.  A  number  of  other  investigations 
have  since  confirmed  his  results.  Too  often  the  school  gives 
no  opportunity  to  make  up  for  this  deficiency  and  the  result 
is  that  pupils  become  drilled  in  a  "word  education"  and  lack 
the  power  either  to  think  clearly  or  deal  intelligently  with  a 
concrete  situation  requiring  tact  and  mental  power.  Hygiene 
has  an  interest  in  developing  healthy  mental  powers  as  well 
as  preventing  injury.  The  meaning  of  all  this  is,  therefore, 
that  during  his  early  years  the  child  in  the  grades  should  be 
put  into  possession  of  a  wealth  of  concrete  ideas  and  of  the 
ability  to  use  them,  not  introduced — much  less  driven— to 


574  EDUCATIONAL  HYGIENE 

the  working  out  of  complicated,  abstract  problems  like  some 
that  have  found  their  way  into  our  arithmetics,  where  the  es- 
sential thing  is  a  logical  trick. 

The  span  of  attention  is  more  limited  in  the  child  than  in 
the  adult.  Also,  the  span  for  immediate  memory  is  shorter 
in  the  earlier  years  than  later  in  life.  That  is,  the  quantity 
of  material  that  can  be  held  in  mind  for  immediate  repro- 
duction is  considerably  less.  The  child  often  does  not  un- 
derstand a  long  sentence,  even  though  it  be  presented  in 
simple  terms,  because  the  first  part  of  it  is  forgotten  ere  the 
last  part  of  it  is  heard.  In  presenting  material,  therefore, 
sentences  should  be  short,  definite,  and  clear.  Enumeration 
of  a  number  of  conditions  that  must  be  held  in  mind  and  upon 
which  the  correct  answer  depends  leads  to  confusion  and 
serves  rather  to  obstruct  than  to  facilitate  development  of 
power  to  think.  In  a  conversation  on  this  topic  a  teacher  of 
some  years'  experience  recently  said  to  me:  "That's  just  one 
of  the  points  where  I  used  to  fail.  I  would  ask  a  question  and 
then  add  something  to  it  to  make  it  clear,  when  in  reality  I 
was  only  making  it  the  more  confusing  to  the  minds  of  the 
pupils." 

This  is  by  no  means  a  complete  list  of  the  mental  differ- 
ences between  the  young  child  on  the  one  hand  and  the  adoles- 
cent or  adult  on  the  other,  but  possibly  these  cases  will  serve 
to  illustrate  the  principle  that  a  hygienic  instruction  is  one 
which  is  fitted  to  the  stage  of  mental  as  well  as  physical  de- 
velopment of  the  child. 

Condition  of  Health. — Instruction  in  school  should  not 
proceed  independently  of  the  condition  of  the  pupil's  health. 
Most  of  the  topics  related  to  this  principle  belong  properly 
in  a  discussion  of  school  medical  inspection  and  are  discussed 
in  detail  elsewhere  in  this  work.  Little  more  than  an  enumer- 
ation of  the  most  important  ones  is  needed  in  this  connection. 

Freedom  from  disease,  a  well-nourished  condition,  good 
posture,  good  digestion,  ability  to  sleep  well — all  these  are 
essentials  for  mental  as  well  as  physical  development.    There 


THE    GENERAL   HYGIENE   OF   INSTRUCTION  575 

should  be  no  hindrances  to  respiration.  The  child  with  ob- 
structions such  as  adenoid  growths  in  his  nasal  passages  is 
less  able  to  give  sustained  attention  and  profits  much  less 
from  instruction  than  the  one  that  breathes  freely.  Kaffe- 
mann  is  reported  to  have  demonstrated  experimentally  that 
children  with  artificial  nasal  obstructions  showed  a  decrease 
in  abihty  to  retain  memory  material.  But  more  than  this, 
it  is  a  well-known  fact  that  the  child  with  adenoids  is  liable 
to  be  inattentive  and  "dull,"  and  that  he  benefits  both  phys- 
ically and  mentally  when  they  are  successfully  removed. 
Attention  has  elsewhere  been  called  to  the  relation  of  physical 
defects  to  school  progress.  Tonsilar  disturbances  and  en- 
larged glands  should  be  carefully  watched  for  and  treated 
when  necessary. 

While  not  attempting  to  state  which  were  the  causal 
factors,  Quirsfeld  reports  that  he  found  among  German  chil- 
dren that  a  condition  of  lack  of  nourishment,  weak  muscu- 
lature, enlarged  glands,  and  weak  mental  powers  were  very 
liable  to  be  found  in  the  same  pupils. 

Since  so  much  of  the  child's  knowledge  must  be  received 
through  ear  and  eye,  it  is  extremely  important  that  these 
organs  be  free  from  defects.  Special  classes,  if  need  be, 
should  be  furnished  for  those  children  who  hear  poorly. 
Meumann  says  that  such  conditions  as  bad  hearing  may  go 
so  far  as  to  cause  moral  injury.  Care  of  the  eyes  is  equally, 
if  not  more,  important.  All  the  things  that  may  be  said  re- 
garding hygiene  of  vision  apply  here. 

Good  teeth,  properly  cared  for,  are  essential  to  the  health 
and  comfort  of  the  child  and  also  to  good  school  work. 
Numerous  school  dental  cHnics  in  this  and  other  countries  are 
evidence  that  this  fact  is  being  recognized.  Rose  has  re- 
ported that  among  German  children  physical  development 
was  greatly  influenced  by  defective  teeth,  that  poorer  physical 
development  was  accompanied  by  poorer  mental  power,  and 
that  the  poorer  the  teeth  the  worse  on  the  average  were  the 
grades  of  the  children. 


576  EDUCATIONAL  HYGIENE 

Finally,  children  with  nervous  disorders  and  symptoms  of 
neurotic  condition  need  the  most  careful  attention.  They 
should  be  free  from  strain  of  all  kinds,  in  order  to  guard 
against  nervous  and  mental  disturbances  that  may  be  both 
serious  and  permanent. 

Some  precaution  is  needed,  also,  to  prevent  the  spread  of 
such  things  as  bad  motor  habits,  tics,  and  even  in  many  cases 
certain  defects  of  speech,  which  may  easily  become  "psychic 
contagions." 

The  above  Hst  of  topics  is  perhaps  not  entirely  new,  but 
the  thing  to  be  emphasized  here  is  that  these  things  are  im- 
portant for  instruction,  also  for  mental  development.  The 
maxim  should  always  be:  "Health  first,  then  instruction." 

Optimum  Conditions  for  Work. — Having  fitted  the  de- 
mands of  the  school  to  the  child's  innate  ability,  stage  of 
development,  and  condition  of  health,  the  next  step  should  be 
to  look  to  the  conditions  under  which  the  work  is  to  be  done. 

Sufl&cient  room  for  work,  and  an  abundance  of  light  and 
pure  air,  are  essential.  Undue  distractions  should  be  elimi- 
nated as  far  as  possible.  School-buildings  should  be  located 
in  quiet  districts. 

Subjects  requiring  strenuous  effort  should  be  studied  during 
the  early  forenoon,  when,  as  experiments  have  shown,  the 
maximum  of  ability  for  the  day  is  reached.  Habit  studies 
and  routine  work  may  come  in  the  late  forenoon  or  in  after- 
noon hours.  Daily  application  to  strenuous  work  at  a  time 
when  energy  is  at  its  ebb  may  be  expected  to  result  in  nerv- 
ousness, headaches,  and  a  minimum  of  acquisition  of  real 
power.  On  the  other  hand,  periods  of  the  most  strenuous 
work  should  not  immediately  follow  each  other.  Ability  is 
influenced  by  preceding  work  as  well  as  by  time  of  day. 
Strenuous  tasks  should  be  followed  by  a  period  of  relaxation 
or  lighter  work  before  other  equally  strenuous  tasks  are  begun. 

Seasonal  variations  have  also  been  noticed.  Api)arently 
the  tide  of  mental  ability  runs  low  during  the  spring  and 
early  summer,  when  physical  growth  is  greatest.    School  work 


THE   GENERAL  HYGIENE   OF   INSTRUCTION  577 

should  be  a  little  less  strenuous  at  this  time.  On  the  basis  of 
the  same  facts,  the  spring  vacation  finds  a  hygienic  justifica- 
tion. 

Some  attention  must  be  paid  to  the  social  environment. 
The  presence  of  the  teacher,  the  presence  of  other  pupils,  the 
knowledge  of  their  attitudes  toward  the  work  being  done — 
all  these  are  of  significance  for  the  healthful  exercise  of  the 
pupil's  mental  powers.  Too  great  variation  of  ability  in  one 
class  is  bad.  The  best  are  not  stimulated  to  work;  the  poorest 
are  too  much  discouraged  to  do  so.  On  the  other  hand,  abihty 
should  not  be  perfectly  uniform.  A  sHght  inequahty  stimu- 
lates the  entire  group  to  better  efforts  and  greater  develop- 
ment. Social  environment  is  also  a  factor  in  the  determina- 
tion of  whether  home  work  is  good  or  bad.  For  example, 
Schmidt  found  that  among  the  parents  of  children  who  were 
doing  home  work  some  could  be  classed  as  "demanding," 
some  as  "hindering,"  and  still  others  as  "indifferent."  Hy- 
gienists  seem  to  be  agreed  that  there  should  be  no  regular 
home  work  for  any  of  the  pupils  of  lower  grades.  There  is 
less  agreement  with  reference  to  home  work  by  pupils  of  the 
upper  grammar  grades,  but  most  admit  that  high-school 
pupils  may  do  some  home  work  without  injury. 

These  conditions  need  attention  if  the  surroundings  of  the 
school-child  are  to  be  made  conducive  to  efficiency  of  work 
and  a  healthful  development.  School  work  is  sufficiently  un- 
natural and  difficult  at  best,  and  injuries  sufficiently  numerous. 
Every  precaution  is  needed  to  keep  the  child  body  and  child 
mind  growing  and  reacting  normally  and  to  prevent  the  fur- 
ther multiphcation  of  "school  injuries."  Conditions  should 
therefore  be  as  nearly  the  best  as  it  is  possible  to  obtain. 

Alternation  of  Work  and  Rest. — That  the  development  of 
an  organism  is  conditioned  upon  the  rhythmical  alternation  of 
functioning  and  inactivity  is  a  fundamental  biological  law. 
That  this  is  true  of  physical  development  has  been  demon- 
strated by  every  athlete  that  ever  went  into  training.  Based 
upon  this  is  the  hygienic  principle  that  periods  of  work  should 


578  EDUCATIONAL   HYGIENE 

alternate  with  periods  of  rest.  The  old  maxim  that  "exercise 
strengthens"  suggests  at  once  the  classic  example  of  the 
blacksmith's  arm,  but  a  similar  influence  from  exercise  is  as 
real  in  case  of  mental  as  in  case  of  physical  development.  On 
the  other  hand,  we  scarcely  need  be  reminded  that  the  black- 
smith does  not  use  his  arm  without  ceasing.  Rest  and  time 
to  rebuild  tissue  are  essential.  And  if  this  is  true  for  the 
hardened  muscular  cells  of  the  blacksmith's  biceps,  how  much 
more  true  is  it  for  the  delicate  brain  and  nerve-cells  upon 
which  mental  work  depends! 

If  such  analogous  reasoning  does  not  suffice,  then  one  needs 
only  to  observe  the  nervousness,  the  inattention,  the  inability 
to  think,  that  are  displayed  by  a  group  of  pupils  at  the  close 
of  a  long  and  fatiguing  school  session. 

Work  is  essential  to  development,  but  so  also  is  rest;  and 
both  development  and  health  are  conditioned  upon  their 
proper  balance.  It  is  well  for  the  child  to  work  until  he  is 
tired,  but  he  must  have  opportunity  to  rest  afterward,  not  set 
to  work  immediately  upon  another  fatiguing  task.  The  meas- 
ure of  this  balance  is  the  readiness  with  which  the  child  re- 
covers. Prolonged  work,  whether  physical  or  mental,  is  sure 
to  result  in  nerve  strain,  and  a  condition  of  nerve  strain  is  a 
condition  of  strength  drain.  When  the  strength  thus  drained 
is  not  recovered  within  a  reasonable  time,  there  is  danger  of 
injury. 

The  applications  of  this  principle  are  many.  I  mention 
a  few  of  the  more  important.  The  position  in  which  the  work 
of  the  school  is  to  be  done  should  be  natural.  When  the 
strain  from  unnatural  positions  becomes  too  great,  the  child 
slumps  down  in  an  attempt  to  ease  himself — to  get  needed 
rest — and  bad  posture  with  its  attendant  ills  results.  Strenu- 
ous physical  exercise  should  not  follow  difficult  mental  work, 
especially  where  movements  are  difficult  and  require  close 
attention.  This  does  not  rest;  it  only  increases  the  fatigue. 
Conversely,  a  strenuous  physical  exercise  should  never  be 
followed  immediately  by  difficult  mental  work.     Exercises  in 


THE    GENERAL   HYGIENE   OF   INSTRUCTION  579 

singing,  especially  those  in  which  attention  to  the  reading  of 
music  is  involved,  should  never  be  substituted  for  actual  rest. 
They  require  attention  and  expenditure  of  energy  and  are 
more  liable  to  produce  than  to  relieve  fatigue.  Finally,  by  no 
means  least  in  importance,  frequent  recesses  should  be  given. 
Better  work  has  been  shown  to  result  when  recesses  were  fre- 
quent and  short  than  when  they  were  less  frequent,  even 
though  longer. 

Mental  Hygiene 

Mental  hygiene  as  a  science,  the  nativity  of  which  does 
not  date  very  far  back  in  years,  is  founded  largely  upon  con- 
tributions from  psychology,  normal  and  abnormal,  psychiatry, 
physiology,  and  neurology.  These  sciences  have  in  recent 
years  contributed  many  significant  facts  regarding  mental 
functioning  and  mental  development  and  the  conditions  upon 
which  they  depend.  It  has  been  shown  that  much  of  the  so- 
called  abnormality,  and  much  of  the  insanity  even,  is  in  great 
part  the  result  of  faulty  mental  habits  developed  early  in  life. 
The  treatment  for  such  conditions  consists  essentially  in  a  re- 
education in  proper  habits  of  thinking. 

Now,  as  has  been  repeatedly  pointed  out  by  Doctor 
Burnham,  it  is  certainly  a  fact  of  some  significance  that  many 
of  the  patients  now  receiving  their  re-education  in  special 
institutions  were  only  a  few  years  ago  pupils  in  the  public 
schools.  A  properly  applied  mental  hygiene  there  would  have 
instituted  correct  mental  habits  in  a  high  percentage  of  cases 
and  thus  acted,  at  least  in  many  borderline  cases,  as  a  pre- 
ventive of  much  of  the  suffering,  not  to  mention  the  expense 
and  economic  loss,  to  society.  It  is  thus  clear  at  once  that  the 
hygiene  of  instruction  is  in  large  part  a  mental  hygiene,  and 
this  means  that  the  school  must  pay  proper  attention  to  the 
cultivation  of  good  mental  habits. 

Of  prime  importance  here  are  habits  of  attention,  associa- 
tion of  ideas,  and  emotional  expression.  All  these  are  es- 
sential to  instruction  at  every  point.     Each  involves  and  is 


5  So  EDUCATIONAL  HYGIENE 

conditioned  by  the  others  in  almost  every  situation,  so  that  it 
is  almost  impossible  to  discuss  them  separately.  Let  us  there- 
fore turn  attention  for  a  few  moments  to  the  meaning  and  im- 
portance of  each,  taking  up  later  the  applications  to  school 
work  and  the  conditions  upon  which  they  depend. 

Attention. — From  the  functional  view-point,  attention  is 
that  reaction  by  virtue  of  which  elements  in  a  situation  be- 
come more  or  less  clear  in  consciousness.  In  its  simplest, 
most  primitive  form,  the  reaction  is  direct  and  immediate,  in 
response  to  a  stimulus.  In  its  developed  form  it  is  selective 
in  its  nature;  certain  elements  are  either  pushed  into  the 
background  or  "fringe"  of  consciousness  or  excluded  entirely, 
while  others  are  brought  to  the  foreground  and  thus  become 
more  clear. 

But  we  must  take  care  to  interpret  correctly.  Conscious- 
ness is  not  static.  Attention  does  not  render  its  elements 
fixed.  With  a  sort  of  panoramic  sweep  they  change  and  flow, 
creating  ever  a  new  situation.  In  fact,  the  figure  "stream  of 
consciousness"  has  been  very  fittingly  applied.  There  is 
therefore  a  constantly  recurring  readjustment,  a  shift  of  at- 
tention from  moment  to  moment. 

Now  the  ability  to  adjust  to  these  changes,  the  ability  to 
attend  in  a  proper  manner,  is  at  once  vital  to  clear  thinking 
and  to  mental  development.  The  lack  of  this  ability,  on  the 
other  hand,  means  difhculties  of  thought,  abnormalities  of 
mental  development,  and,  in  extreme  cases,  entire  loss  of 
mental  balance  and  a  pathological  condition.  The  whole 
matter  is,  of  course,  complex;  but,  even  though  such  phe- 
nomena as  emotional  response  and  association  of  ideas  are 
involved,  it  may  yet  be  said  that  ability  to  attend  properly 
is  largely  a  matter  of  habit.  This  is  the  point  at  which  the 
topic  of  attention  is  linked  with  the  hygiene  of  instruction. 
It  becomes  the  business  of  the  school  to  drill  pupils,  so  far  as 
is  possible,  in  healthful  habits  of  attention. 

The  healthful  form  for  developed  attention  is  suggested  by 
the  simpler,  more  primitive  form.    As  intimated  before,  this 


THE   GENERAL  HYGIENE   OF   INSTRUCTION  58 1 

is  direct  and  simple,  bringing  one  element  to  the  foreground. 
The  school,  therefore,  should  drill  its  pupils  to  attend  to  a 
situation  in  such  a  way  that  the  essentials  are  brought  to  the 
foreground,  while  unessentials,  whether  relating  to  past, 
present,  or  future,  are  either  excluded  entirely  or  else  pushed 
into  the  background  or  fringe  of  consciousness.  In  ordinary 
terms,  this  means  the  ability  to  concentrate  upon  the  essen- 
tials of  a  situation,  shifting  attention  from  moment  to  moment 
in  a  way  to  present  them  to  consciousness  from  a  new  view- 
point. To  the  problem  of  how  this  is  to  be  accomplished  in 
the  school  we  shall  a  little  later  return. 

Association. — Training  in  good  habits  of  attention  should 
be  paralleled  by  training  in  habits  of  orderly  association  of 
ideas  and  the  avoidance  of  interference.  Briefly  stated,  in- 
terference means  a  struggle  of  ideas  for  possession  of  the  fore- 
ground of  consciousness.  This  problem  has  been  dealt  with 
in  detail  by  Doctor  Burnham,  who  would  make  the  avoid- 
ance of  interference  the  most  general  negative  rule  in  mental 
hygiene.  "We  find  interference  of  association,"  he  says,  "in 
an  infinite  number  of  forms,  from  the  conflict  of  simultaneous 
stimuli  in  the  nervous  system  and  the  relatively  simple  in- 
terference of  incipient  motor  habits  up  to  the  confusion  of 
thought  in  the  individual  who  is  worried  or  rattled  or  the 
patient  who  suffers  from  the  insanity  of  doubt." 

All  persons  experience  an  occasional  interference  of  as- 
sociation. For  example,  do  you  spell  receive  with  an  ei  or 
is  it  ie?  Was  it  number  368  or  836  ?  Or,  again,  a  name  can- 
not be  recalled  because  a  similar  name  crowds  to  the  fore- 
ground and  usurps  the  focus  of  consciousness. 

Ordinarily  these  experiences  last  for  but  a  moment,  or  at 
least  for  a  few  minutes,  and  are  apparently  harmless  enough. 
Unfortunately,  however,  this  is  not  always  the  case.  Inves- 
tigations have  shown  that,  especially  in  case  of  persons  with 
unstable  nervous  systems,  conflicts  of  ideas  or  of  complex 
systems  of  ideas  may  under  the  influence  of  strong  emotional 
toning  finally  result  in  serious  pathological  conditions  such  as 


582  EDUCATIONAL  HYGIENE 

obsession,  dissociation,  disintegration  of  personality,  and  loss 
of  sanity. 

I  do  not  mean  to  assume  that  every  case  is  to  be  taken  as 
an  indication  of  a  pathological  condition.  I  do  wish,  however, 
to  lay  stress  upon  the  necessity  of  proper  habits  of  association 
of  ideas  as  an  essential  to  mental  health  and  the  development 
of  the  power  to  think  clearly;  and  I  insist  that  it  is  imperative 
that  the  hygiene  of  instruction  take  account  of  these  facts, 
namely:  (i)  In  extreme  cases  interference  of  association  may 
form  the  basis  of  bad  habits  of  thought  which  lead  later  to 
pathological  conditions  and  loss  of  sanity;  (2)  interference  is 
ordinarily  a  common  and  normal  occurrence  but  is  often  ab- 
normal, and  forms  an  obstruction  to  the  free  flow  of  ideas  and 
to  logical  thinking  and  a  hindrance  to  proper  mental  de- 
velopment; (3)  the  most  successful  method  for  treatment  of 
pathological  cases — the  method  of  re-education — points  to 
education  in  proper  habits  of  association  in  the  early  years  as 
the  best  means  "for  prevention  of  such  cases ;  (4)  it  therefore 
devolves  upon  the  school,  which  assumes  the  burden  of  edu- 
cating and  moulding  the  child  to  so  great  an  extent — largely 
by  means  of  association  of  ideas — to  see  that  instruction  be 
such  as  to  avoid  as  much  as  possible  the  abnormal  interfer- 
ence of  these  associations  and  that  proper  habits  be  developed. 

Emotions. — Habits  of  emotional  response  make  up  a  third 
clement  of  significance  for  mental  health.  Indeed,  it  is  im- 
possible absolutely  to  separate  the  child's  emotional  from  his 
intellectual  development — a  fact,  sad  to  say,  that  has  not 
always  been  recognized  by  the  schools. 

The  influence  of  affective  or  emotional  elements  upon  con- 
scious reaction  has  been  clearly  demonstrated  in  laboratory 
experiments  during  the  last  decade.  Evidence  of  this  is  found 
in  the  "attitudes"  that  are  so  often  to  be  dealt  with  in  the 
working  out  of  psychological  problems.  One  needs  but  to 
mention  a  few  of  them,  such  as  attitudes  of  indifference,  prej- 
udice, approval,  etc.,  to  show  that  they  are  normal  matters  of 
every-day  experience.    But  they  are  not  always  necessarily  so. 


THE   GENERAL  HYGIENE   OF   INSTRUCTION  583 

A  persistent  habit  of  assuming  an  attitude  of  disapproval  may, 
for  example,  readily  transform  an  individual  into  what  is 
popularly  termed  a  chronic  grouch;  certainly  a  habit  that 
is  not  conducive  to  mental  health.  Similarly  many  other  bad 
attitudes,  such  as  jealousy,  suspicion,  distrust,  etc.,  may  be- 
come so  ingrained  as  to  become  a  hindrance  to  normal,  health- 
ful mental  reactions.  But  these  are  only  mild  cases.  In  ex- 
treme cases,  when  combined  with  other  bad  mental  habits, 
such  as  interference,  for  example,  affective  and  emotional 
toning  becomes  an  important  factor  in  the  development  of 
pathological  conditions.  Interference,  emotionally  toned, 
begets  worry;  worry  aggravates  interference;  and  so  the  evil 
spreads  until  the  victim  is  hopelessly  enmeshed  in  a  tangle  of 
conflicting  ideas  and  compelling  emotions  from  which  it  is 
impossible  for  him  to  extricate  himself. 

It  is  a  duty  of  the  school  to  do  all  in  its  power  to  develop 
in  the  pupils  those  attitudes  that  are  conducive  to  mental 
health.  Possibly  the  whole  secret  for  doing  this  has  not  yet 
been  given  to  the  world  in  full;  but  a  large  part  of  the  secret 
is  contained  in  the  following  expression:  Freedom,  Naturalness, 
Self-expression,  Interest. 

Practical  Applications.— Some  practical  suggestions  as  to 
how  the  principles  of  mental  health  may  be  applied  in  the 
schoolroom  are  in  place  here. 

(i)  Make  the  instruction  such  as  to  enlist  the  permanent 
interest  of  the  child.  Faithful,  energetic  work  on  a  problem 
of  vital  interest,  even  though  it  be  not  of  long  duration,  will 
do  much  to  develop  good  habits  of  attention  and  of  associa- 
tion. 

(2)  The  injunction  to  guard  against  overfatigue  is  again 
in  place  here.  The  fatigued  child  is  the  inattentive  child, 
or,  perhaps  better,  the  badly  attentive  child.  It  is  in  this 
condition,  too,  that  associations  go  wrong  and  interference 
is  liable  to  be  initiated,  and  unhealthful  attitudes  toward 
work  develop. 

(3)  Make  statements  and  questions  commensurate  with 


5^4  EDUCATIONAL  HYGIENE 

the  limited  attention  span  of  the  child.  Do  not  "scatter" 
the  attention  and  initiate  interference  by  means  of  much  and 
confusing  diction. 

(4)  Problems  and  tasks  should  not  be  too  complex. 

"One  thing  at  a  time,  and  that  done  well, 
Is  a  very  good  rule,  as  many  can  tell." 

In  beginning  penmanship,  for  example,  it  is  too  much  to  ex- 
pect the  young  child  to  attend  to  the  form  of  the  letters, 
spelling  of  the  words,  holding  to  the  line,  neatness,  manner  of 
holding  the  pen,  and  posture,  all  at  one  time. 

(5)  Take  account  of  the  kind  of  work  to  be  done  and  use 
a  few  moments  to  teach  the  pupil  how  to  study  it.  For 
example,  a  leading  question  or  two  may  make  the  difference 
between  a  history  lesson  carefully  studied  with  interest  and 
good  attention,  or  a  history  lesson  which  is  uninteresting  and 
"memorized"  imperfectly  with  many  a  shift  of  attention. 

(6)  In  making  assignments,  give  a  definite  task  commen- 
surate with  the  child's  ability,  require  him  to  do  it,  then  give 
some  chance  for  relaxation. 

(7)  See  that  each  child  in  the  class  or  in  the  school  suc- 
ceeds at  something.  Not  to  do  so  is  to  bid  for  discourage- 
ment and  unhealthful  attitudes  on  the  part  of  some  pupils. 
Nothing  is  more  true  than  the  old  maxim  that  "  nothing  suc- 
ceeds like  success." 

(8)  Select  as  teachers  persons  who  are  optimistic,  joyous, 
tactful,  enthusiastic,  and  sympathetic;  and  let  teachers  them- 
selves practise  good  mental  hygiene  in  the  realization  that 
most  irritable,  pessimistic,  exacting  attitudes  of  mind  can  be 
changed. 

Summary 

To  summarize  very  briefly,  the  problems  of  the  hygiene 
of  instruction  are  those  which  have  to  do  with  the  health  and 
the  normal  development  of  both  body  and  mind.     The  sub- 


THE    GENERAL   HYGIENE   OF   INSTRUCTION  585 

ject  is  therefore  broad  in  its  scope.  As  a  result  of  the  solu- 
tion, or  partial  solution,  of  the  problems  concerned,  the  fol- 
lowing general  principles  may  be  stated:  The  demands  of  in- 
struction should  be  fitted  first  of  all  to  the  child's  innate 
ability,  stage  of  development,  and  condition  of  health,  after 
which  he  should  be  given  as  nearly  as  possible  optimum  con- 
ditions in  which  to  work;  work  and  rest  should  be  properly 
alternated  in  order  to  avoid  injury  from  overfatigue;  finally, 
regard  should  be  had  for  the  laws  of  mental  health,  so  far  as 
they  are  known,  care  being  taken  to  develop  proper  habits 
of  attention,  association  of  ideas,  and  emotional  response. 


CHAPTER  XXXI 
THE  HYGIENE  OF  SCHOOL  SUBJECTS 

In  this  chapter  the  attempt  is  made  to  indicate  some  of 
the  applications  of  the  principles  indicated  in  the  preceding 
one  to  some  of  the  most  important  subjects  of  the  school 
curriculum.  It  is  impossible  to  make  a  complete  list,  but  the 
treatment  of  these  most  important  subjects  will,  I  hope,  be 
of  value. 

Reading. — The  emphasis  upon  reading  is  so  nearly  uni- 
versal, both  throughout  the  school  years  and  throughout  Ufe, 
the  amount  of  time  spent  upon  it  is  so  great,  and  other  sub- 
jects in  the  school  depend  so  much  upon  it,  that  compliance 
with  the  demands  of  hygiene  for  as  nearly  optimum  conditions 
as  possible  becomes  imperative.  Without  attaching  special 
significance  to  their  order,  let  us  turn  attention  to  the  most 
important  of  these  demands. 

(i)  First,  hygiene  demands  that  proper  regard  be  had  for 
the  posture  of  the  child.  Suitable  seats  and  desks,  more 
complete  descriptions  of  which  are  to  be  found  in  another 
chapter,  are  a  necessity.  They  should  be  suited  to  the  size 
of  the  pupil  and  so  constructed  as  to  make  possible  an  easy, 
erect  position,  without  strain;  and  they  should  support  the 
book  in  a  way  to  make  reading  possible  without  stooping 
and  without  bending  forward  the  head  or  the  body.  Standing 
in  Hne  and  holding  heavy  volumes  in  position  for  reading 
should  not  be  required  of  pupils.  Indeed,  heavy  volumes  for 
regular  use  in  any  subject  should  be  avoided,  especially  in 
case  of  the  younger  pui)ils.  The  carrying  of  such  books  is 
liable  to  be  injurious. 

(2)  In  the  second  place,  hygiene  demands  that  oral  read- 

586 


THE  HYGIENE   OF   SCHOOL   SUBJECTS  587 

ing  should  have  proper  regard  for  the  organs  of  speech.  Here 
are  involved  organs  of  respiration,  vocalization,  and  articu- 
lation, and  any  rules  having  reference  to  their  proper  care, 
development,  and  training  are  applicable  to  the  hygiene  of 
reading. 

In  proper  amounts  and  under  proper  conditions  oral  read- 
ing is  a  healthful  exercise.  Good  breathing  exercises  and  the 
development  of  good  breathing  habits  are  of  value.  The 
use  of  pure  tone  should  be  cultivated,  but  it  should  not  be  a 
monotone.  Reading  with  expression  brings  various  muscles 
into  play,  thus  preventing  rapid  fatigue  of  the  vocal  organs. 
Training  in  habits  of  articulation  is  also  valuable,  since  both, 
in  school  and  out  a  little  articulation  is  better  than  much 
loud  talking  for  making  one's  self  heard,  and  it  is  much  less 
injurious  to  the  vocal  organs. 

Reading  should  never  be  so  long  nor  so  loud  as  to  cause 
strain,  hoarseness,  or  overfatigue  of  the  vocal  organs.  Es- 
pecially in  the  early  years,  excessive  strain  should  be  avoided; 
also  at  the  time  of  voice  mutation,  which  usually  occurs  at 
about  the  pubertal  period.  So  also  in  case  of  colds  or  sore 
throat,  after  certain  diseases  that  affect  the  throat,  and  where 
there  are  nasal  obstructions  or  tonsilar  disturbances,  over- 
strain should  be  guarded  against.  Bad  nasal  and  tonsilar 
conditions  should  receive  medical  attention  immediately. 

Speech  defects  constitute  a  special  problem.  Their  causes 
are  numerous,  many  of  them  lying  outside  the  school,  and  in 
so  far  as  treatment  is  concerned  the  cases  belong  in  the  hands 
of  specialists.  Within  the  school,  however,  oral  work  may  be 
of  value  by  drilHng  in  habits  of  slow,  deep  breathing,  rhyth- 
mical speaking  and  proper  articulation  of  words,  thus  pre- 
venting or  correcting  bad  habits  which  are  liable  to  be  con- 
tributing factors  to  defects  of  speech. 

(3)  Hygiene  demands  that  care  be  taken  to  prevent 
school-books  from  becoming  media  for  the  spread  of  disease. 
Books  pass  from  hand  to  hand  and  are  liable  to  be  thumbed 
by  a  number  of  individuals.    Turning  of  pages  with  the  tip 


588  EDUCATIONAL  HYGIENE 

of  the  finger  moistened  in  the  mouth  should  never  be  tolerated. 
Special  precautions  are  necessary  in  case  of  supplementary 
readers  that  are  handed  from  class  to  class,  also  library  books 
that  circulate  from  home  to  home.  The  same  apphes  to 
pencils  and  other  objects,  as  taken  up  in  the  chapter  on  school 
sanitation. 

(4)  A  fourth  demand  has  reference  to  the  organs  of  vision. 
All  rules  regarding  the  care  of  the  eyes  apply  here.  Some  of 
these  need  special  emphasis.  Light  should  be  abundant,  but 
should  not  fall  on  books  and  desks  in  a  way  to  cause  a  glare. 
Rules  for  posture  are  important  again  in  this  connection.  The 
distance  of  the  book  from  the  eyes  should  not  be  such  as  to 
cause  strain  of  the  visual  organs  in  reading — never  less  than 
twelve  inches,  according  to  a  special  committee  report  before 
the  American  School  Hygiene  Association,  191 1. 

Near  work  should  alternate  with  that  giving  opportunity 
for  distance-vision,  thus  relieving  the  strain  caused  by  ac- 
commodation of  the  eye  for  close  vision.  In  the  report  of 
the  British  Association  for  the  Advancement  of  Science,  191 2, 
the  committee  appointed  to  inquire  into  the  influence  of  school- 
books  upon  eyesight  writes  as  follows  (p.  298) : 

Children  who  do  too  much  close  eye  work  suffer  in  various  ways: 
some  simply  from  fatigue,  showing  itself  by  inattention,  mental 
weariness,  temporary  dimness  of  sight,  or  aching  of  the  eyes  and  head; 
some  from  congestion  of  the  eyes,  as  shown  by  redness,  watering,  and 
frequent  blinking.  A  certain  number,  in  circumstances  which  predis- 
pose them  to  the  disorder,  develop  strabismus,  or  squint.  Some  others 
—and  these  cases  are  perhaps  the  most  important  of  all — develop  pro- 
gressive myopia. 

A  special  committee  of  the  American  School  Hygiene  As- 
sociation fixes  the  maximum  time  for  the  uninterrupted  use 
of  the  eyes  for  near  work  at  fifteen  minutes  for  the  first  school 
year,  increasing  to  one  hour  in  the  later  adolescent  years. 

Again,  the  undeveloped  condition  of  the  eye  in  the  early 
years,  the  frequent  lack  of  ability  to  fuse  together  the  images 


THE  HYGIENE   OF   SCHOOL   SUBJECTS  589 

from  the  two  eyes,  the  inabiHty  to  hold  the  book  at  proper 
distance  from  the  eyes  because  of  the  shortness  of  the  arms, 
these  and  other  facts  indicate  that  instruction  in  reading 
should  not  begin  too  early.  The  British  committee  recom- 
mended that  extended  reading  from  books  be  postponed  until 
the  age  of  seven  at  least.  Oral  work,  pictures,  blackboard 
work,  and  wall  charts  are  recommended  for  use  up  to  this  age. 
The  "make  up"  of  school  texts  is  important.  Author- 
ities are  practically  agreed  as  to  the  fitness  of  the  following 
requirements : 

Paper  should  be  white,  without  gloss,  opaque,  and  sufficiently 
hard  so  that  type  does  not  press  through. 

Illustrations  should  be  plain  and  without  j5ne  detail,  especially 
in  the  lower  grades. 

Ink  should  be  good  black  and  evenly  distributed  over  the  page. 

Maximum  length  of  lines  should  be  90  mm.  (The  British  com- 
mittee gives  100  to  g3  mm. — i,^^  to  4  inches.) 

For  beginners,  lines  should  not  end  in  the  middle  of  a  word. 

Series  of  short  lines  by  the  side  of  illustrations  should  not  be  used. 

Margins  should  be  sufficiently  wide  so  that  the  eye  does  not  swing 
off  the  paper,  and  those  next  the  fold  of  the  book  should  be  wide 
enough  to  prevent  printing  from  being  hidden  by  the  curvature  of 
the  paper. 

Type  should  be  clean-cut,  making  lettering  with  clear  and  well- 
defined  lines,  especially  in  the  upper  half,  and  whites  and  blacks 
should  be  evenly  balanced.     Italics  should  be  used  very  little. 

The  committee  of  the  American  School  Hygiene  Association 
gives  the  following  as  minimum  standards  for  type,  spacing, 
and  leading  for  the  earlier  school  grades: 

A.  First  grade — 

(i)  The  height  of  the  small  letters  should  be  at  least  2.6  mm., 
with  the  other  dimensions  in  proportion. 

(ii)  The  width  of  the  vertical  stroke  should  be  from  .4  to  .5  mm. 
(iii)  The  space  within  the  letters  should  be  from  .8  to  .9  mm, 
(iv)  The  space  between  the  letters  should  be  about  i  mm. 

(v)  The  space  between  the  words  should  be  about  3  mm. 
(vi)  The  leading  should  be  from  4  to  4.5  mm. 


590  EDUCATIONAL  HYGIENE 

B.  For  the  second  and  third  years  the  standard  may  be  reduced 

slightly,  but  the  letters  should  not  be  less  than  2  mm.  in 
height  and  the  leading  should  be  4  mm. 

C.  For  the  fourth  year  height  and  leading  should  not  be  less  than 

1.6  mm.  and  3  mm.  respectively.     It  would  be  better  to  re- 
tain the  standard  of  the  fourth  year  through  the  sixth  year. 

The  British  committee  is  somewhat  less  liberal  in  its  recom- 
mendations for  size  of  type,  but  more  liberal  as  regards  lead- 
ing, or  interlinear  space. 

(5)  But,  after  all,  standards  and  objective  material  are 
but  means  to  an  end.  These  are  furnished  and  should  be 
properly  used  in  order  that  the  child  may  learn  to  read.  And 
reading  is  to  interpret  symbols  presented.  It  is  something 
psychological,  a  series  of  mental  processes.  A  fifth  and  per- 
haps most  important  demand  of  hygiene  is  therefore  that 
reading  should  not  be  detrimental  to  the  mental  health  of 
the  child. 

Now,  the  earlier  years  are  the  time  par  excellence  for  play, 
for  telling  of  stories,  and  for  relating  personal  experiences,  all 
of  which  begin  the  development  of  and  furnish  the  basis  for 
habits  of  attention,  ability  to  concentrate  upon  essentials 
while  ignoring  unessentials,  practise  in  memorizing  things  of 
interest,  and  in  giving  logical  expression  to  ideas — all  essen- 
tials to  mental  health,  as  outlined  in  the  preceding  chapter. 
On  the  other  hand,  as  Doctor  Fitz  has  pointed  out,  reading 
too  early  is  liable  to  crowd  out  these  activities  and  leave  the 
child  grinding  over  the  memorization  of  symbols  that  are 
arbitrary  and  uninteresting.  He  develops  the  habit  of  look- 
ing too  much  at  the  symbols,  not  through  them,  to  the  thought 
— a  habit  which  may  retard  him  in  his  future  reading  when 
the  getting  of  the  thought  is  essential. 

The  statement  may  therefore  be  repeated  here  with  em- 
phasis that  regular  work  in  reading  should  not  be  required 
of  the  child  in  the  early  years.  Many  of  the  best  educators 
maintain  that  reading  should  be  postponed  until  the  age  of 
eight.     To  quote  Doctor  Fitz: 


THE   HYGIENE    OF    SCHOOL   SUBJECTS  59 1 

Experience  has  shown,  over  and  over  again,  that  the  child  who 
begins  to  read  at  eight  years  is  in  no  wise  handicapped  in  his  later 
educational  progress.  He  has  the  inestimable  value  of  the  advantage 
of  intense  interest,  rounded  by  his  sense  of  power  in  unlocking  the 
secrets  of  books  and  papers  after  the  fashions  of  his  elders.  Increased 
maturity  makes  the  slow,  irksome  task  pleasurable  and  easy. 

The  slower  association  time  of  the  child  makes  it  wrong 
to  demand  too  rapid  reading,  especially  when  the  material  is 
new  and  unfamiliar.  Ideas  that  should  be  associated  with 
the  symbols  come  slowly  and  attempts  to  force  them  are 
liable  to  cause  either  wrong  associations  or  interference. 

To  summarize  briefly,  then,  the  reading  of  books  in  the 
school  should  not  be  required  under  conditions  that  are  lia- 
ble to  cause  bad  posture  or  to  result  in  injury  to  the  organs 
of  speech  or  of  vision;  books  themselves  should  not  be  media 
for  the  spread  of  disease;  and  finally,  instruction  in  reading 
should  be  given  neither  at  such  an  early  age  nor  by  such  meth- 
ods that  it  may  become  a  hindrance  to  mental  development 
and  the  formation  of  good  mental  habits. 

Arithmetic. — As  one  of  the  ''three  R's"  arithmetic  has 
always  had  a  place  of  great  importance  in  the  schools.  Its 
general  hygienic  requirements  are  much  the  same  as  those  for 
reading. 

The  great  amount  of  desk  work  that  must  be  done  neces- 
sitates attention  to  the  proper  adjustment  of  seats  and  desks 
with  a  view  to  securing  good  posture.  Height  of  blackboards 
from  the  floor  also  should  correspond  to  the  size  of  the  pupils. 

Care  of  the  eyes  makes  it  necessary  that  proper  conditions 
of  lighting  be  furnished  and  that  the  ''make  up"  of  texts 
conforms  to  all  the  requirements  given  in  the  preceding  sec- 
tion for  reading-books  in  general.  Special  emphasis  should  be 
placed  upon  the  requirement  that  diagrams  and  illustrative 
drawings  be  clear  and  that  all  figures,  especially  fractions, 
be  in  large,  good  type.  The  British  committee  would  have 
all  mathematical  symbols  in  slightly  larger  type  than  other 
material.     Blackboards  should  be  of  proper  color  and  of  good 


592  EDUCATIONAL  HYGIENE 

material,  and  lettering  to  be  read  by  pupils  in  the  room  should 
be  sufficiently  large  and  clear  to  be  read  without  difficulty  or 
eye-strain. 

With  a  view  to  taking  precautions  against  spread  of  dis- 
ease the  use  of  slates  may  well  be  prohibited  entirely,  also 
the  loaning  of  pencils  among  pupils.  Crayons  should  be 
selected  with  care  and  pupils  should  be  taught  how  to  erase 
the  blackboards  properly  in  order  to  avoid  as  far  as  possible 
filling  the  air  with  dust. 

From  the  view-point  of  the  child's  mental  development 
a  number  of  things  are  significant.  First,  the  age  at  which 
formal  arithmetical  study  begins  should  not  be  too  early.  The 
power  of  abstract  reasoning  develops  late,  as  was  stated  in 
the  preceding  chapter.  Attempts  to  force  its  development 
at  too  early  an  age  are  liable  to  result  in  retardation  or  arrest. 
Doctor  Triplett  has  shown  that  too  much  stress  on  arithmetic 
in  the  early  years  often  results  in  bad  mental  habits,  such 
as  the  incessant  counting  habit  known  as  arithmomania  or 
the  fixation  of  incongruous  ''number  forms"  which  are  liable 
to  persist  as  obstructions  to  logical  arithmetical  thinking,  A 
number  of  the  best  authorities  maintain  that  arithmetic 
should  be  postponed  until  the  age  of  eight  or  ten  years. 
Finally,  bad  attitudes  may  be  the  result  of  too  early  stress 
upon  the  subject.     Says  Doctor  Fitz: 

.  .  .  Much  of  the  aversion  to  arithmetical  problems  found  later 
is  undoubtedly  due  to  the  disheartening  drill  of  this  primary  work. 
Here  again  the  child  who  begins  arithmetic  at  eight  or  ten  years  of 
age  finds  himself  able  to  take  it  up  quickly  and  has  the  liking  for  it 
that  easy  mastery  always  gives. 

Again,  collected  statistics  show  that  from  one-sixth  to 
one-fourth  of  the  time  of  the  school  is  devoted  to  the  study 
of  arithmetic — an  amount  entirely  out  of  proportion  to  the 
value  of  the  subject  for  mental  development.  Courses  are 
as  a  rule  made  to  include  too  much.  Topics  are  taught 
because  found  in  the  texts  and  Ihev  are  in  the  texts  because 


THE   HYGIENE   OF   SCHOOL   SUBJECTS  593 

they  have  always  been  in  other  texts  before.  The  result  of 
all  this  is,  in  many  cases,  overpressure,  nervousness,  and 
injury  to  mental  health  and  development. 

A  number  of  mental  processes  are  involved  in  arithmetical 
work.  Much  would  be  gained  for  the  hygiene  of  the  subject 
if  this  were  recognized  in  a  practical  way.  For  example, 
where  mere  association  of  ideas  is  involved,  account  of  the 
fact  should  be  taken  and  drill  in  formation  of  the  proper  as- 
sociations should  always  precede  drill  for  speed.  Or,  again, 
much  of  the  subject  is  merely  application  of  a  new  form 
of  expression,  a  new  language,  to  a  form  of  reasoning  with 
which  the  pupil  is  already  familiar.  Thus,  both  ratios  and 
common  fractions  are  neither  more  nor  less  than  unexe- 
cuted divisions,  decimals  are  specialized  fractions  written  in 
new  form,  and  percentage  is  perfectly  simple  when  treated 
as  a  subdivision  of  decimals  with  symbol  series  of  its  own. 
Doctor  McDougle  has  emphasized  the  proper  sequence  and 
proper  relationship  of  these  topics  for  the  pedagogy  of  the 
subject.  The  hygienic  value  from  such  a  procedure  would 
perhaps  be  even  greater,  eliminating  innumerable  difficulties 
of  thought  and  causes  of  interference  and  unhealthful  atti- 
tudes. Doctor  Burnham  has  emphasized  the  importance  of 
eliminating  the  type  of  complex  problem  which  is  in  its  es- 
sentials a  logical  trick  and  has  little  to  do  with  reasoning 
about  numerical  relations.^ 

Geography. — The  demands  of  hygiene  upon  geography, 
in  so  far  as  its  influence  upon  physical  health  is  concerned, 
have  particular  reference  to  posture  and  to  vision. 

In  case  of  the  former  the  conditions  within  the  school- 
room and  the  hygienic  demands  are  practically  the  same  as 
in  case  of  reading,  except  in  the  special  work  of  the  drawing 
of  maps.  There  the  rules  found  under  the  discussion  of 
drawing  will  apply.  It  may  be  added,  however,  that  map- 
drawing  should  not  constitute  a  large  part  of  the  course. 

'  See  also  Jessup's  studies  of  eliminations  in  arithmetic  in  the  1915  year-book 
of  the  National  Society  for  the  Study  of  Education  and  in  the  1914  and  1915 
Proceedings  of  the  National  Education  Association. 


594  EDUCATIONAL  HYGIENE 

As  regards  the  care  of  Ihe  eyes,  also,  the  general  rules  in- 
dicated in  the  discussion  of  reading  apply.  In  addition  to 
these,  however,  some  special  precautions  are  made  necessary 
by  the  extensive  use  of  maps.  First,  the  matter  of  the  con- 
struction of  maps  is  of  importance.  They  should  not  be 
made  to  contain  too  much  of  detail,  and  should  only  contain 
such  lettering  as  is  necessary  to  make  their  meaning  clear. 
The  suggestion  of  Burgerstein  that  all  the  important  names 
in  wall  maps  be  large  enough  to  be  read  by  the  entire  class 
is  good.  The  special  committee  of  the  British  Association 
for  the  Advancement  of  Science  recommends  that  no  school- 
atlas  should  use  type  smaller  than  eight-point,  with  a  mini- 
mum height  of  short  letters  of  1.2  mm.,  and  that  for  chil- 
dren below  the  age  of  nine  years  nothing  below  ten-point, 
with  a  minimum  height  of  short  letters  of  1.6  mm.  (yV  inch) 
should  be  used.  Separate  maps  should  be  used  to  represent 
physical  and  political  characteristics.  As  regards  the  use  of 
maps  a  suggestion  of  the  British  committee  may  be  quoted: 

Location  by  reference  lines  should  be  taught  from  the  beginning, 
and  children  should  not  be  allowed  to  hunt  for  a  name  in  an  undi- 
rected fashion,  as  they  may  thus  have  to  read  fifty  names  in  finding 
the  one  sought. 

In  a  more  general  way,  geography  may  be  said  to  be  a 
subject  of  health  opportunity.  Outdoor  excursions  and  trips 
to  places  of  interest  may  do  much  for  the  general  health  of 
the  pupils  and  are  to  be  encouraged. 

From  the  view-point  of  mental  development,  also,  geog- 
raphy may  be  said  to  be  a  study  of  opportunity.  Pedagog- 
ically,  the  aim  is  to  teach  of  the  earth  as  the  home  of  man. 
If  this  is  done  properly,  with  the  use  of  concrete  material 
wherever  possible  and  with  many  properly  managed  outdoor 
excursions,  the  child  comes  into  possession  of  a  wealth  of 
concrete  ideas  which,  as  investigations  have  shown,  are  so 
often  lacking  in  school-children  but  which  are  essential  to 
I)roper  mental  development. 


THE   HYGIENE   OF   SCHOOL   SITBJECTS  595 

On  the  other  hand,  investigations  have  shown  that  unless 
special  care  is  taken  in  the  use  of  such  material  as  charts, 
maps,  and  globes  there  may  develop  peculiarities  and  bad 
mental  habits  which  may  persist  as  obstructions  to  clear 
thinking.  "When  I  get  big  I  am  going  to  move  into  that 
State,  'cause  there  the  grass  and  flowers  and  trees — everything 
is  all  pink,'"  confided  a  small  boy  to  his  teacher  as  he  pointed 
to  a  bright  spot  on  the  map  before  him.  This  is  a  typical 
case.  Doctor  Triplett  reports  that  no  individuals  asserted 
that  map-drawing  had  produced  inability  to  image  places 
on  the  earth,  a  map  being  called  up  instead.  One  student 
reported  as  follows  on  the  result  of  four  years  of  study  of 
geography,  supplemented  by  much  practise  in  locating  places 
upon  a  large  colored  map: 

...  In  consequence  I  still  think  of  all  States  as  little  patches  of 
green,  red,  or  yellow,  as  the  case  may  be.  That  result  I  do  not  regret 
so  sorely,  for  it  is  a  common  thing.  But,  worse  than  all,  the  map  was 
hung  during  all  those  years  upon  the  south  wall  of  the  schoolroom. 
This  reversed  all  the  directions  and  I  still  think  of  Washington  State, 
for  instance,  as  being  southeast  of  here,  Florida  as  being  northwest, 
etc.  It  would  be  almost  impossible  for  any  one  who  had  not  had  a 
similar  experience  to  imagine  how  very  strong  this  association  is. 

Speaking  of  such  cases  as  "arrests"  and  commenting  upon 
their  causes  and  the  form  they  take.  Doctor  Triplett  writes: 

.  .  .  The  prevalent  idea  that  one  must  be  able  to  locate  every 
place,  whether  of  consequence  or  not,  on  the  ground  that  it  may  be 
needed  in  one's  reasoning  appears  responsible  for  the  close  memory 
grind  of  insignificant  details.  Overemphasis  on  the  study  of  map- 
drawing  is  without  doubt  the  strongest  element  in  the  production  of 
the  effects  characteristic  of  these  arrests.  A  large  majority  being 
of  the  visual  type,  extreme  concentration  on  a  symbol  during  the  most 
plastic  period  of  hfe  habituates  to  the  use  of  the  fixed  mental  images 
of  maps,  globes,  etc. 

Maps  should  be  used  to  aid  in  the  instruction  of  pupils 
concerning  the  things  they  represent,  not  merely  as  subject- 


596  EDUCATIONAL   HYGIENE 

matter,  to  be  learned  as  they  stand ;  map  questions  should  be 
used  only  in  reviewing  and  summarizing,  never  in  introducing 
pupils  to  the  study  of  a  country,  except  in  the  most  general 
way;  and  care  should  be  taken  always  to  see  that  the  ideation 
of  the  pupil  reaches  beyond  the  map  to  the  actual  things  it 
represents. 

Writing. — The  most  important  phases  of  the  hygiene  of 
writing,  in  so  far  as  physical  health  is  concerned,  have  refer- 
ence to  its  influence  upon  posture,  vision,  and  the  develop- 
ment of  muscular  control. 

The  necessity  of  good  seats  and  desks  of  the  proper  size 
for  the  purpose  of  securing  good  posture  is  self-evident. 
As  regards  other  requirements,  possibly  a  brief  summary  of 
those  enumerated  by  Doctor  Burgerstein  would  be  of  most 
value  in  this  connection.     They  are  as  follows: 

(i)  Body  erect,  without  bending  to  the  side  and  without  a  twist 
in  the  horizontal  axis,  and  with  breast  not  touching  the  edge  of  the 
desk. 

(2)  Head  very  slightly  inclined,  eyes  being  as  far  from  the  paper 
as  height  of  the  body  in  good  position  will  allow — never  less  than 
thirty  centimetres. 

(3)  Feet  neither  crossed  nor  drawn  under  the  seat,  but  with  soles 
resting  on  foot-rest  or  on  the  floor. 

(4)  Arms  held  so  that  elbows  are  about  a  handbreadth  from  the 
body,  forearms  with  about  two-thirds  their  length  on  the  table  and 
almost  at  right  angles  to  each  other. 

(5)  Hand  with  palm  turned  slightly  to  the  left  and  resting  upon 
the  nail  of  the  bent  little  finger,  upon  which  the  other  fingers  are  sup- 
ported, one  above  the  other. 

(6)  Penholder,  which  should  not  be  too  short,  should  not  be 
grasped  too  near  the  pen;  held  with  upper  portion  pointing  toward 
the  elbow. 

(7)  Writing  periods  to  alternate  with  rest  periods,  gymnastic 
exercise,  or  oral  instruction  whenever  the  majority  of  the  class  begin 
to  show  signs  of  fatigue. 

(8)  Copy-book  so  placed  that  it  is  in  front  of  the  median  line  of 
the  body;  lines  parallel  to  the  edge  of  the  desk  in  vertical,  but  slanting 
upward  to  the  right  for  slant  script. 


THE   HYGIENE   OF    SCHOOL   SUBJECTS  597 

Proper  attention  to  vision  makes  necessary  the  following 
requirements : 

(i)  Well-recognized  rules  for  lighting  should  be  observed. 

(2)  The  use  of  slates  should  be  prohibited. 

(3)  Writing-paper  should  have  a  good  surface,  being  neither  rough 
nor  glaring,  and  should  not  be  so  transparent  as  to  allow  script  to  be 
visible  through  it. 

(4)  Ink  should  be  a  good  black. 

(5)  Guide  lines  on  the  paper  should  be  of  a  good  black,  never 
light  blue,  as  is  often  the  case,  and  should  not  be  complex. 

(6)  Script  should  not  be  too  small — small  letters  not  less  than 
three  to  five  millimetres  in  height,  according  to  Burgerstein. 

Some  care  should  be  taken  for  the  neuromuscular  develop- 
ment.    Here  may  be  mentioned  the  following: 

(i)  Strenuous  drill  in  writing  should  not  begin  too  early,  as  it 
requires  too  much  of  the  accessory  muscles.  If  reading  should  be  post- 
poned until  eight  years,  writing  should  be  postponed  until  even  later. 

(2)  Script  should  be  plain,  without  flourish,  and  should  not  be  too 
small. 

(3)  Pencils  and  penholders  should  be  long  and  sufficiently  thick 
to  be  grasped  with  ease. 

(4)  Copy-book  lines  should  not  be  too  long.  In  fact,  books  should 
not  be  used,  a  few  sheets  of  paper  of  proper  size  being  better. 

(5)  The  necessity  for  frequent  periods  of  rest  needs  re-emphasiz- 
ing here.  Prolonged  strain  due  to  too  much  writing  may  result  in 
what  is  known  as  "writer's  cramp." 

(6)  When  first  beginning  to  learn  to  write,  children  should  be  al- 
lowed to  use  coarser  material,  such  as  blackboard  and  chalk,  thus 
avoiding  the  fatiguing  finer  adjustments  of  hand  to  pencil,  etc. 

Lack  of  space  prohibits  going  into  the  controversy  of 
vertical  versus  slant  script.  On  the  whole,  it  may  be  said 
that  investigations  seem  to  have  indicated  that,  from  the 
view-point  of  influence  upon  both  vision  and  posture,  the  ad- 
vantage is  with  the  former,  but  the  present  semi-slant  systems 
may  easily  be  used  without  sacrifice  of  posture  if  teachers 
use  "never-failing  watch  and  care." 

So  far  as  mental  development  and  health  are  concerned,  the 


59S  EDUCATIONAL   HYGIENE 

problems  of  learning  to  write  are  those  of  association  of  the 
idea  with  the  proper  writing  movement  to  produce  the  symbol 
and  of  the  formation  of  habits.  It  should  be  emphasized 
here  that  learning  correct  forms  should  precede  drills  for 
speed,  and  that  right  habits  should  be  mechanized  as  rapidly 
as  possible,  thus  reducing  the  probability  of  interference  of 
association.^ 

Drawing. — Properly  employed,  drawing  may  be  a  very 
healthful  exercise.  Like  writing,  however,  a  number  of  pre- 
cautions are  necessary  regarding  it. 

General  precautions  are  those  against  injury  from  poison- 
ous colored  crayons,  the  use  of  sharp  thumb-tacks,  or  any 
other  material  that  might  be  injurious.  Aside  from  these,  the 
hygienic  requirements  are  very  similar  to  those  of  the  hygiene 
of  writing. 

Hygienic  chairs,  tables,  and  other  furnishings  are  necessary 
to  good  posture.  Other  special  requirements  are  given  in  the 
theses  prepared  by  a  committee  of  the  Berlin  Lehrverein,  the 
main  points  of  which  are  here  enumerated: 

(i)  Upper  part  of  the  body  free  and  without  strain,  head  inclined 
slightly  forward,  shoulders  equal  height,  feet  separate  with  soles  on 
the  floor. 

(2)  Drawing  surface  directly  before  the  middle  line  of  the  body, 

(3)  Left  forearm  pushed  forward  on  the  table  so  that  the  lower 
part  of  the  upper  arm  lies  just  over  the  surface  yet  so  that  the  body 
may  not  be  supported  by  it.     Left  hand  holds  drawing  surface  lightly. 

(4)  Right  forearm  neither  pressed  close  to  the  body  nor  used  as  a 
prop,  but  placed  to  make  possible  good  free  movement. 

(5)  Right  hand  lightly  supported  on  the  point  of  the  little  finger. 
Wrist  not  touching  surface  of  paper.  Hand  should  not  obscure  the 
line  that  is  being  drawn. 

Proper  care  of  eyes  makes  necessary  these  requirements: 

(i)   Good  conditions  of  lighting. 

(2)  Use  of  white  or  yellow  paper  with  good  surface. 

'See  Freeman,  " The  Teaching  of  Handwriting." 


THE   HYGIENE   OF   SCHOOL   SUBJECTS  599 

(3)  Prohibition  of  drawing — especially  such  as  map-drawing — 
for  home  work. 

(4)  Refraining  from  use  of  fine  lines  and  fine  shadings. 

(5)  Tests  of  vision,  including  color  tests,  before  beginning  tech- 
nical drawing. 

(6)  Frequent  changes  from  near  to  far  vision,  such  as  is  required 
in  drawing  from  models. 

Regard  for  the  child's  motor  development  makes  it  de- 
sirable that  overstrain  from  too  long  periods,  from  use  of 
too  short  or  too  slender  pencils,  drawing  of  too  fine  lines, 
etc.,  be  avoided.  In  all  the  early  years  drawing  should  be 
free-hand,  and  the  materials  should  not  be  too  line.  Tech- 
nical instruction  should  be  postponed  until  near  the  pubertal 
period. 

So  far  as  its  relation  to  mental  hygiene  is  concerned,  drawing 
is  of  great  value  as  a  means  of  expression,  and  normal  expres- 
sion is  a  condition  of  development.  The  spontaneous  drawing 
in  the  early  years  should  therefore  be  encouraged.  Artistic 
expression  and  appreciation  is  a  later  development  and  should 
not  be  insisted  upon  in  the  prepubertal  period. 

Spelling. — Outside  the  school  one  is  rarely  called  upon 
to  spell  words  except  when  expressing  his  thoughts  in  writing, 
and,  especially,  in  letter-writing.  The  chief  aim  in  teaching, 
therefore,  should  be  the  association  of  the  proper  letter  sym- 
bols with  each  other  and  of  these  with  the  proper  writing 
movements. 

From  either  view-point,  pedagogical  or  hygienic,  it  is  es- 
sential that  these  associations  be  direct  and  that  the  habitu- 
ation of  the  writing  movements  be  carried  to  such  a  degree 
that  they  will  come  as  little  as  possible  into  consciousness 
to  obstruct  the  free  flow  of  ideas.  In  brief,  learning  to  spell 
should  not  become  the  cause  of  interference  of  association. 

For  securing  the  results  aimed  at,  several  general  prin- 
ciples may  be  laid  down: 

(i)  Wherever  possible,  make  spelling  secondary  to  some  other 
activity.     For  example,  in  the  early  grades  especially  spelling  should 


OOO  EDUCATIONAL  HYGIENE 

be  taught  incidentally,  along  with  other  subjects.  The  act  of  spelling 
is  thus  not  made  an  end  in  itself,  and  the  danger  of  too  much  "symbol 
consciousness"  is  reduced.  Special  drill  classes  may  well  be  post- 
poned until  about  the  fourth  school  year. 

(2)  Differences  in  type  of  mental  imagery  make  it  necessary  that 
several  methods  be  used,  appealing  to  visual,  auditory,  hand-motor  and 
speech-motor  imagery,  etc. 

(3)  Investigations  of  the  most  economical  employment  of  time 
seem  to  indicate  that  about  fifteen  minutes  per  day  in  the  upper 
grades  is  all  that  may  profitably  be  spent  in  column  drill. 

(4)  Avoid  showing  the  child  incorrect  forms.  Correct  errors  by 
showing  the  right  spelling.  Never  strengthen  the  imagery  of  the  wrong 
form  by  making  it  prominent. 

(5)  Teach  homonyms  separately,  thus  avoiding  the  dangers  of  in- 
terference of  association. 

(6)  Finally,  make  the  habits  of  writing  whole  words  with  one 
impulse  of  the  will  mechanical  as  rapidly  as  possible.  Methods  for 
doing  this  are:  copying,  writing  from  dictation,  rapid  writing  of 
familiar  material,  such  as  poems,  etc.  With  attention  fixed  upon  the 
thought  or  the  words,  the  matter  of  spelling  is  left  more  and  more  to 
the  hand.' 


Other  Subjects. — Limits  of  space  make  it  impossible  to 
extend  the  list  of  special  treatments  further.  Possibly  the 
treatments  here  given  will  be  sufficient  to  illustrate  rather 
fully  the  application  of  the  principles  which  were  pointed  out 
in  the  preceding  chapter.  Some  of  the  other  subjects  that 
should  be  rightly  included  are: 

(i)  Music,  the  essential  hygienic  considerations  in  which 
are  attention  to  vision,  to  care  of  the  vocal  organs,  especially 
at  time  of  voice  mutation,  and  to  the  development  of  neuro- 
muscular powers  where  the  use  of  instruments  is  involved; 

(2)  Language,  in  which  the  most  important  problems  are 
those  of  association  of  ideas  and  formation  of  habits; 

(3)  The  more  scientific  subjects,  which  properly  should  be 
begun  rather  late,  but  which  require  special  attention  to  the 
requirements  of  mental  hygiene. 

In  any  specific  case  the  problem  will  be  the  application 

*  See  investigations  by  Ayres,  Buckingham,  Ballou,  O'Shea,  and  others. 


THE   HYGIENE    OE    SCHOOL   SUBJECTS  6oi 

of  the  general  hygienic  principles  laid  down  in  Chapter  XXX. 
These  will  never  be  found  to  conflict  with  sound  psycholog- 
ical and  pedagogical  principles.  Freedom  of  expression,  cor- 
rect habits  of  attention,  orderly  association,  a  lively  interest 
in  the  work  at  hand,  all  are  vital  to  both  health  and  growth. 
They  constitute  the  magic  which  the  pedagogist  must  use  in 
order  not  merely  to  preserve  from  injury,  but  to  transform 
the  immature  individuals  daily  thronging  our  schools  into  the 
master  minds  who  will  solve  the  problems  of  the  future. 


PART  IV 

THE  HYGIENE  OF  THE  COLLEGE 

CHAPTER  XXXII 
THE  HYGIENE  OF  WOMEN'S  COLLEGES 

It  is  advisable,  in  discussing  the  problem  of  the  health 
provisions  in  women's  colleges,  to  outline  briefly  the  develop- 
ment which  has  taken  place  in  the  attitude  of  the  women's 
colleges  toward  the  health  of  their  students,  so  that  we  may 
theorize  possibly  more  intelligently  regarding  the  future  of 
this  side  of  the  college  education  of  women. ^ 

The  health  provisions  in  women's  colleges  concerned  them- 
selves in  the  early  days  with  two  phases  of  the  girl's  life — the 
care  that  was  given  to  her  in  case  of  actual  illness  and  the 
amount  and  kind  of  exercise  she  took.  The  question  of  the 
food  a  girl  had  was  left  entirely  to  the  women  in  charge  of 
the  table,  who  too  often  had  the  question  of  expense  more  at 
heart  than  the  wholesomeness  of  the  food.  The  problem  of 
the  amount  of  work  was  left  to  the  oversight  of  the  faculty. 
The  question  of  the  amount  of  sleep  a  girl  should  have  was 
sometimes  decreed  authoritatively,  as  at  Smith,  and  some- 
times left  to  the  discretion  of  the  individual  students,  as  at 
Vassar. 

Illness  Care. — In  most  of  the  women's  colleges  there  has 
been  from  the  beginning  some  provision  for  the  care  of  the 
students  in  case  of  illness.  In  accordance  with  this  plan  at 
Vassar  a  regular  resident  physician  was  from  the  beginning, 

'  This  ( hajiter  applies  also,  of  course,  to  the  health  development  of  women 
in  coeducational  colleges. 

6o2 


THE   HYGIENE   OF   WOMEN's   COLLEGES  603 

in  1863,  connected  with  the  college,  and  some  rooms  were 
set  aside  as  an  infirmary  for  the  care  of  sick  students.  Other 
colleges,  such  as  Smith,  introduced  the  resident  physician 
some  years  after  the  estabHshment  of  the  college.  The  care 
of  the  students  could  here  be  intrusted  to  the  town  physi- 
cian until  the  size  of  the  college  warranted  the  entire  services 
of  a  doctor.  At  Bryn  Mawr  there  is  no  regular  resident 
physician,  but  a  physician  spends  two  hours  daily  at  the 
college  for  consultation.  The  sick  student  is  taken  for  granted 
as  a  necessary  part  of  the  college  to  be  provided  for. 

The  duties  of  the  resident  physician  did  not  concern  them- 
selves with  the  educational  side  of  the  college.  She  was  a 
practising  physician  and  in  complete  charge  of  the  infirmary 
or  small  hospital  where  those  students  taken  ill  during  the 
course  could  be  isolated  and  properly  cared  for.  The  infir- 
mary was  from  the  beginning  a  part  of  the  regular  equipment 
of  the  college.  The  doctor  had  no  supervision  over  the  hygi- 
enic conditions  under  which  the  students  Hved.  If  the  food 
were  bad  or  the  students  suffered  from  its  inadequacy  they 
must  complain  to  the  heads  of  houses.  If  the  curriculum  were 
too  confining  for  the  students,  so  their  health  suffered  in 
consequence,  they  must  complain  to  the  faculty.  The  in- 
dividual student's  health,  like  her  clothes  and  spending- 
money,  was  her  own  affair  unless  she  were  ill  enough  to  re- 
quire medical  attention  or  hospital  care. 

Physical  Education.— The  phrase  "physical  education" 
had  at  this  time  scarcely  come  into  existence.  Education 
meant  "mental"  training,  and  this  was  to  be  the  entire 
significance  of  the  diploma  awarded.  Yet  it  was  early  rec- 
ognized that  exercise  was  an  important  element  in  the  life 
of  the  college  student,  as  keeping  her  in  good  physical  con- 
dition and  as  enhancing  her  mental  powers.  It  was  in  the 
early  days  an  adjunct  rather  than  a  distinct  part  of  the  cur- 
riculum. At  Vassar  this  exercise  took  the  form  of  horseback 
riding,  where  one  of  the  prominent  campus  buildings  is  the 
old  riding  academy,  now  the  art  museum.     In  most  women's 


6o4  EDUCATIONAL  HYGIENE 

colleges,  however,  as  also  at  Vassar,  the  gymnasium  was  a 
part  of  the  college  from  the  very  beginning.  The  work  has 
always  been  "required"  in  our  Eastern  women's  colleges. 
The  matter  of  requirement  was  never,  however,  seriously 
pressed.  It  was  a  simple  matter  for  a  student  to  bring 
from  her  family  physician  a  certificate  of  "ill  health"  which 
would  exempt  her  from  work.  It  was  easy,  too,  for  the- 
students  to  "cut  classes"  repeatedly.  A  number  of  girls  in 
one  of  our  large  colleges,  in  the  early  days,  who  did  not 
care  for  the  work,  remained  away,  determined  not  to  at- 
tend until  compelled.  They  were  never  called  to  account 
for  it.  In  short,  the  students  were  quick  to  recognize  that 
the  question  of  the  getting  of  a  degree  was  in  no  way  bound 
up  with  the  question  of  adequate  or  good  gymnasium  work, 
and  the  latter  was  accordingly  slighted. 

The  gymnasium  work  at  first  was  not  and  is  not  now 
closely  co-ordinated  with  the  work  of  the  resident  physician. 
Although  both  the  gymnasium  department  and  the  resident 
physician  are  interested  in  maintaining  a  high  standard  of 
health  among  the  students,  the  line  is  rather  sharply  drawn 
between  their  functions.  Greater  co-operation  exists  perhaps 
at  Wellesley,  where  the  gymnasium  department  is  more  truly 
a  hygiene  department. 

Here,  as  interest  in  organized  sports  grew,  an  athletic 
association  came  into  existence.  This  was  initiated  by  the 
student  body  and  is  controlled  by  them  in  close  co-operation 
with  the  gymnasium  department  or  department  of  hygiene 
where  such  exists. 

Resident  Physician. — The  resident  physician  has  always 
occupied  in  the  college  a  position  of  dignity.  She  was  in  a 
sense  "set  apart"  by  the  character  of  her  occupation;  that  is, 
her  interests  were  not  supposed  to  be  and  probably  were  not 
concerned  with  education  as  were  those  of  professors  and 
instructors.  Nevertheless  she  ranked  with  the  professors 
and  took  part  in  the  faculty  meetings,  though  merely  to  throw 
light  on  the  physical  condition  of  individual  students.     She 


THE  HYGIENE   OF   WOMEN^S  COLLEGES  605 

would  have  been  overstepping  the  mark  had  she  ventured  to 
take  part  in  a  discussion  on  any  academic  question  or  general 
educational  policy  or  problem. 

The  g}Tnnasium  teacher  was  at  first  a  curiously  discon- 
nected factor  in  the  college.  Of  course  this  was  to  be  expected 
in  a  situation  in  which  physical  training  was  regarded  merely 
as  a  means  of  keeping  the  students  in  good  condition  so  they 
could  accomplish  their  "real"  education  without  detriment 
to  their  health.  At  present,  however,  the  head  of  the  phys- 
ical-training department  at  Vassar  ranks  as  an  associate  pro- 
fessor with  the  title  of  "Director  of  Physical  Training."  The 
director  of  the  department  of  hygiene  at  Wellesley  is  head 
of  her  department  in  precisely  the  same  sense  as  that  of  any 
other  department  in  the  college  and  with  the  same  powers. 

There  has  always  been  some  effort  expended  by  the  col- 
lege in  educating  the  student  in  hygienic  ways  of  living.  This 
education  has  consisted  of  a  course  of  lectures  on  hygiene, 
usually  not  counting  toward  the  degree  and  usually  given  to 
the  freshmen  by  the  resident  physician.  Subsequently  in 
the  history  of  the  college  an  elective  in  physiology  was  intro- 
duced— open  to  the  upper  classes. 

Progress  in  Physical  Education. — The  principal  changes 
that  have  come  about  in  the  physical  education  of  women 
have  been  as  follows: 

(i)  Further  exactions  looking  toward  better  attendance  in 
gymnasium  work.  Gymnasium  work  in  the  women's  col- 
leges is  at  present  required  for  the  first  and  second  year  classes 
in  a  truer  sense  than  in  the  early  days.  At  Vassar,  if  a  student 
misses  too  many  hours  of  gymnasium  work,  she  is  compelled 
to  make  it  up  before  graduation.  If  her  freshman  and  sopho- 
more work  in  gymnasium  at  Wellesley  is  unsatisfactory,  in 
other  words,  if  she  is  "conditioned"  in  her  g}Tnnasium  work, 
she  makes  it  up  in  her  junior  or  senior  year.  But  at  Welles- 
ley the  gymnasium  work  and  outdoor  work  "count  toward 
the  degree  "  of  A.B.,  which  is  not  the  case  in  any  other  woman's 
college  that  I  know  of.    This  fact  has  always  made  the  gym- 


6o6  EDUCATIONAL  HYGIENE 

nasium  work  at  most  colleges  seem  to  the  students  of  less 
importance  than  their  other  work — a  sort  of  an  addendum 
or  superfluity  which  many  of  them  accordingly  resent. 

(2)  Closer  attention  is  given  to  the  individual  student  on 
entering  college  and  after.  Careful  records  are  now  kept 
of  the  past  and  present  histories  of  the  students,  the  results 
of  the  physical  tests  to  which  they  are  put;  and  at  Wellesley 
the  condition  of  the  backs  and  feet  is  noted.  At  Wellesley, 
also,  special  classes  in  restrictive  gymnasium  work  and  cor- 
rective gymnasium  work  are  carried  on  for  students  who 
cannot  take  the  regular  work  or  who  would  profit  by  more 
particularly  adapted  work. 

(3)  The  third  most  noticeable  change  toward  improving 
the  health  conditions  of  the  college  is  in  the  increased  interest 
in  sports  among  women.  As  the  colleges  have  grown  the  in- 
terest in  basket-ball,  tennis,  rowing,  hockey,  and  field-day 
contests  has  steadily  increased,  until  at  the  present  time  en- 
thusiasm for  sports  is  one  of  the  striking  features  of  the 
woman's  college.  This  increases  the  interest  in  gymnasium 
work.  As  soon  as  the  student  can  be  made  to  feel  that  the 
gymnasium  work  better  fits  her  for  the  competitive  sports 
she  is  ready  to  enter  more  eagerly  into  the  disciplinary  ac- 
tivity. 

The  interest  in  sports  has  been  used  to  raise  the  standard 
of  health  and  good  carriage.  No  student  at  Wellesley  can 
row  on  the  crew  unless  she  has  a  good  carriage.  The  ''train- 
ing" of  the  students  taking  part  in  the  sports  also  impresses 
upon  all  somewhat  the  value  of  a  regular  life  as  an  aid  to 
physical  efficiency. 

All  these  provisions  for  the  health  of  students  are  at  pres- 
ent more  developed  at  Wellesley  than  at  the  other  women's 
colleges — so  I  shall  give  here  a  brief  description  of  what  has 
been  accomplished  at  this  college  by  its  hygiene  department.' 

The  reason  why  this  side  of  girls'  education  has  been  more  developed  at 
Welk'sley  than  at  any  other  women's  colleges  is  in  part  because  of  the  connec- 
tion with  the  college  of  a  normal  school  of  hygiene.     This  has  tended  to  raise 


THE   HYGIENE   OF   WOMEN 's   COLLEGES  607 

Health    Requirements  on  Entrance} — Applicants  for   ad- 
mission must  be  organically  sound.     A  student  can  be  refused 
admission  if  suffering  from  a  disease  which  would  be  sufficient" 
handicap  to  make  full  work  an  impossibility.  /^ 

Organic  soundness  is  determined  by  the  examining  physi- 
cians. Every  girl  is  examined  before  college  opens  not  only 
as  to  the  soundness  of  lungs  and  heart,  but  as  to  condition 
of  throat,  eyes,  ears,  reflexes,  and  even  back  and  feet.  Strength 
tests,  which  include  a  drawing  of  the  torso  by  the  aid  of  the 
Demeny  thoracimeter  and  the  anthropometric  measurements, 
are  made  and  each  young  woman  is  graded  on  her  carriage. 
Those  students  who  have  scoliosis  or  exaggerated  physiological 
curves  are  put  into  special  classes  in  corrective  gymnasium 
work.  Those  who  are  unequal  to  full  work  on  account  of 
heart  weaknesses  or  recent  operation  or  other  special  weak- 
nesses are  put  into  a  class  for  restrictive  work.  Compara- 
tively few  are  forbidden  gymnasium  work  altogether. 

If  a  student  is  organically  sound,  but  not  sufficiently  strong 
to  undertake  full  academic  work,  she  can  be  compelled  to  take 
the  course  in  five  years  instead  of  four.  By  far  the  majority 
of  the  students  are  put  into  the  regular  gymnasium  work — 
about  80  to  90  per  cent — where  they  are  given  progressive 
work  in  gymnastics,  dancing,  games,  and  sports. 

Gymnasium  work  is  required  of  the  freshmen  and  sopho- 
mores during  the  winter  months  two  periods  a  week,  and  an 
elective  class  is  held  for  juniors  and  seniors.  In  some  of  the 
women's  colleges  gymnasium  work  is  required  four  periods  a 
week  during  the  winter  months.  This  is  not  practicable  at 
Wellesley  owing  to  the  amount  of  walking  necessitated  by 

by  example  and  comparison  the  standard  of  vigor  among  the  college  students. 
Also  the  director  of  the  department  of  hygiene  at  Wellesley  College  is  not  the 
actual  teacher  of  gymnasium  work,  as  is  the  gymnasium  director  at  most  col- 
leges, so  that  she  has  more  time  and  opportunity  for  proper  organization  of 
the  department. 

'  The  description  of  conditions  at  Wellesley  College  is  taken  largely  from 
a  paper  written  by  Miss  Amy  M.  Romans,  director  of  the  Hygiene  Department, 
and  read  before  the  Fourth  International  Congress  on  School  Hygiene  at  Buf- 
falo, x\ugust,  1913. 


6o8  EDUCATIONAL  HYGIENE 

the  long  distances  between  buildings.  The  average  freshman 
walks  from  three  to  six  miles  a  day.  During  fall  or  spring 
unorganized  games  are  carried  on  for  freshmen  on  the  general 
playground.  For  sophomores,  juniors,  and  seniors  there  are 
rowing,  hockey,  basket-ball,  tennis,  baseball,  golf,  archery, 
field  and  track  sports.  Each  student  participates  in  one  of 
these  at  least  three  times  a  week  during  the  first  five  weeks 
in  the  fall  and  last  six  weeks  in  the  spring. 

On  the  theoretic  side  the  freshmen  are  required  to  attend 
a  course  of  lectures  on  hygiene,  one  a  week  throughout  the 
entire  year.  This  course  counts  one  hour  toward  the  degree 
of  A.B,  The  practical  work,  two  periods  a  week  during  both 
freshmen  and  sophomore  years,  counts  one  hour  toward  the 
degree  of  A.B.  The  total  number  of  hours  required  at  Welles- 
ley  for  the  A.B.  degree  is  fifty-nine.  This  makes  the  hygiene 
requirement  about  one-thirtieth  of  the  total  requirement. 

The  resident  physician  at  Wellesley  attends  the  meetings 
of  the  academic  council,  and  is  consulted  in  regard  to  the 
physical  condition  of  individual  students. 

The  question  of  the  amount  of  sleep  a  student  should  have 
is  left  to  the  discretion  of  the  student,  the  amount  of  work  the 
student  can  carry  to  the  faculty,  the  food  and  housing  con- 
ditions to  the  officers  of  administration.  The  department  of 
hygiene  may  suggest  changes,  but  it  has  no  authorized  juris- 
diction over  details  of  the  housing  and  eating  conditions. 

Suggested  Developments. — The  changes  which,  it  seems 
to  me,  should  be  brought  about  in  our  women's  colleges  are 
first  along  those  lines  suggested  by  the  changes  that  have 
already  come  about.  Supervised  exercise  must  be  required 
in  the  real  sense  of  the  word  "required."  There  is  a  strong 
tendency  on  the  part  of  many  young  women  not  to  take 
enough  exercise,  a  tendency  that  is  increased  by  pressure  of 
book  work.  This  attitude  is  perhaps  more  marked  in  women 
than  in  men,  and  should  be  seriously  considered  in  planning 
an  educational  situation  for  women.  It  is  due  in  large  part 
to  the  fact  that  as  a  girl  approaches  maturity  the  restrictions 


THE   HYGIENE    OF   WOMEN' S   COLLEGES  609 

of  conventionality  close  in  upon  her  far  more  than  on  her 
brother,  limiting  her  exercise  to  such  as  can  be  taken  with 
long  skirts  and  propriety.  She  can  no  longer  play  tennis  or 
take  part  in  any  game  requiring  running  without  change  of 
dress.  Even  the  bicycle  has  gone  out  of  fashion  in  many 
communities.  This  throws  the  girl  back  upon  those  sports 
which  are  less  simple  and  require  more  preparation  and  pre- 
arrangement — as  tennis,  horseback  riding,  dancing,  or  basket- 
ball. As  a  result  of  this  many  girls  prefer  to  take  no  exercise 
regularly  but  walking,  as  tennis  and  similar  sports  cannot  be 
played  unless  one  have  consecutive  hours  and  opportunity  for 
change  of  skirt.  Moreover,  all  vigorous  exercises  are  taken 
too  intermittently,  perhaps  only  Saturday  afternoons  or  on 
holidays. 

Gymnasium  work  counteracts  this  tendency  and  is  a  far 
more  important  part  of  a  girl's  life  at  college  than  is  generally 
recognized.  The  last  one  to  recognize  its  importance  is  the 
girl  herself.  She  seldom  realizes  her  own  physical  defects, 
and  is  often  more  desirous  to  "look  stylish"  than  to  be  strong 
and  healthy.  To  foster  bodily  improvement  is  difficult  in  a 
college  milieu  where  mental  requirements  are  so  strenuously 
urged.  And  this  emphasis  is  achieved  not  so  much  by  public 
opinion  as  by  requirement.  So  many  hours  for  the  A.B. 
degree!  These  hours  must  be  accomplished  to  graduate. 
But  in  the  majority  of  women's  colleges  gymnasium  work 
has  no  such  significance.  Of  course  it  is  the  requirement 
slighted.  Granting  the  extreme  importance  of  gymnasium 
work  for  girls  who  will  not  take  regular  exercise,  should  not 
this  subject  count  toward  the  degree  of  A.B.?  Would  it  be 
such  an  unfortunate  change  for  the  A.B.  degree  to  stand  for 
a  certain  amount  of  physical  excellence  ?  Only  by  a  require- 
ment which  equals  in  importance  that  of  mental  achievement 
shall  we  ever  persuade  girls  of  the  necessity  of  adequate  care 
of  the  body.  And  if  the  higher  education  of  women  is  to  be 
justified  it  must  not  be  associated  with  physical  inferiority. 

The  attention  to  the  needs  of  the  weak  student  should 


6 10  EDUCATIONAL  HYGIENE 

continue  through  classes  in  corrective  and  restrictive  work 
until  our  standards  of  admission  are  improved. 

Attitude  of  the  Public. — Other  changes  that  should  be 
brought  about  are  along  the  lines  suggested  by  the  changes 
that  have  come  about  in  the  attitude  of  the  public  toward 
health  in  general. 

(i)  Health  is  no  longer  regarded  as  something  a  person 
has  or  has  not,  irrespective  of  the  conditions  of  his  life  and 
modes  of  living.  We  are  coming  to  recognize  more  than  ever 
that  the  average  person  who  lives  wisely  will  be  well. 

(2)  We  are  recognizing  also  the  importance  of  health  as 
never  before.  Health  is  not  only  regarded  nowadays  as  an 
asset — greater  for  the  average  person  than  book  knowledge — 
but  an  obligation.  Perhaps  the  period  of  a  girl's  life  between 
the  years  of  eighteen  and  twenty-one  are  not  so  important  as 
regards  her  physical  development  as  between  the  years  of 
twelve  and  eighteen,  but  they  are  none  the  less  a  most  impor- 
tant time,  during  which  she  should  be  storing  up  more  energy 
than  she  expends,  not  expending  more  than  she  is  storing. 
The  strains  of  a  college  life  ought  not  to  equal  those  of  a 
business  or  professional  life.  She  is  still  in  the  stage  of 
"preparation,"  physical  as  well  as  mental. 

For  these  reasons  we  believe  that  the  energies  of  the 
health  department  in  a  woman's  college  should  be  directed 
constructively  toward  increasing  the  girls'  physical  powers 
and  preventing  rather  than  curing  illness.  There  must  be 
less  illness  in  the  college,  a  gradual  elimination  of  the  need  of 
a  resident  physican,  and  the  instalment  of  a  health  officer 
whose  duties  shall  be  twofold: 

(i)  To  see  that  the  conditions  under  which  the  students 
are  compelled  to  live  are  healthful. 

(2)  To  see  that  the  students  thoroughly  understand  their 
obligation  to  take  advantage  of  these  conditions. 

Healthful  Conditions. — I  shall  take  up  these  two  points 
separately.  And  first,  what  conditions  is  a  student  entitled 
to   on   entering   a   woman's  college?     We  maintain   that   a 


THE   HYGIENE    OF   WOMEN'S   COLLEGES  6ll 

Student  is  entitled  first  and  foremost  to  work  that  she  can 
carry  in  a  way  that  is  satisfactory  to  herseh"  without  exhausting 
herself.  She  should  have  time  outside  her  work  for  out-of- 
door  exercise  daily,  for  eight  hours  of  sleep  at  night,  and  no 
Sunday  study.  In  most  of  our  women's  colleges  the  schedule 
of  work  is  much  more  exacting  than  the  school  schedule, 
which  has  usually  been  a  five-day  schedule  with  not  over  six 
hours  a  day  of  work.  The  schedule  in  the  college  might  very 
legitimately  be  more  exacting  than  the  school  schedule,  but 
we  should  never  lose  track  of  the  fact  that  the  great  physical 
dangers  in  the  higher  education  of  women  at  the  present  day 
are:  first,  that  under  the  exactions  of  book  learning  the  life 
becomes  too  sedentary — girls  do  not  get  daily  vigorous  ex- 
ercise; and,  second,  they  feel  so  "driven"  by  pressure  of 
student  and  academic  obligations  that  they  acquire  a  neuro- 
muscular tension,  worse  for  the  girls  perhaps  than  the  loss 
of  muscle  power.  To  prevent  girls  from  "dawdling" — also 
bad  physically,  I  admit — we  are  in  danger  of  increasing 
their  required  programme  until  there  is  no  free  time  for  the 
exercise  of  initiative  on  the  part  of  the  original  or  unusual 
student,  while  the  average  student  often  keeps  abreast  of  the 
work  only  at  the  expense  of  hygienic  modes  of  living.  This 
does  not  mean  that  she  breaks  down.  Too  exacting  a  course 
is  not  to  be  measured  by  the  number  of  breakdowns.  The 
question  is,  is  the  student  in  poorer  condition  at  the  end  of 
the  year  than  at  the  beginning?  Nor  is  increase  in  weight 
to  be  taken  as  a  sign  of  improved  physical  condition,  for  it  is 
not  at  all  incompatible  with  decrease  in  muscle  power  and 
tone.  There  are,  of  course,  students  who  can  carry  heavy 
work  without  injury  to  the  health,  students  even  who  can  go 
without  sleep  without  great  permanent  injury.  But  the 
average  student  should  not  be  compelled  to  sit  up  nights  to 
study.  If  she  does  so  because  she  is  overambitious  or  waste? 
her  time,  that  is  her  own  affair. 

The  health  officer  should  also  have  some  oversight  of  the 
students'  diet  or  at  least  the  planners  of  menus  should  have 


bl2  EDUCATIONAL   HYGIENE 

knowledge  of  food  values  and  training  in  dietetics.  The 
student  should  have  a  satisfying  table  which  would  not  need 
much  supplementing  at  the  tea-room  and  soda-water  foun- 
tains. 

The  housing  conditions  should  be  hygienic.  In  some  col- 
leges there  is,  for  instance,  only  one  bathroom  to,  say,  ten 
or  more  girls.  This  makes  a  daily  shower  impossible.  Also 
the  houses  and  classrooms  should  be  properly  heated  and 
ventilated.  These  considerations  should  be  under  strict  col- 
lege supervision. 

Personal  Health  Responsibility. — Having  made  it  possible 
for  a  girl  to  secure  enough  sleep,  to  have  good  food  and  hous- 
ing conditions,  the  next  step  is  to  cultivate  the  right  attitude 
of  mind  in  the  students.  If  the  conditions  over  which  the 
students  have  no  control  are  right,  it  is  an  obligation  on  the 
part  of  the  students  to  make  right  those  conditions  over 
which  they  have  control.  Some  knowledge  of  the  laws  of 
health  is  imperative  to  intelligent  control,  and  such  knowl- 
edge should  be  obtained  through  hygiene  lectures.  The 
sense  of  responsibility  to  which  the  students  should  be  edu- 
cated will  be  developed  only  by  a  change  in  public  sentiment 
toward  student  illnesses. 

The  hygiene  lectures  are  usually  regarded  as  unworthy  of 
academic  credit  and  in  many  cases  probably  are  unworthy. 
In  so  far  as  a  hygiene  lecture  consists  of  a  set  of  directions 
pertaining  to  the  common  decencies  of  life,  as  care  of  the  hair, 
teeth,  general  cleanliness,  etc.,  it  may  be  a  useful  lecture  course 
for  students  with  unsatisfactory  home  conditions,  but  it  is 
neither  fundamental  nor  scientific  enough  to  merit  credit. 

Course  in  Hygiene. — A  hygiene  course  should  consider 
those  ways  of  living  that  markedly  improve  or  seriously  im- 
pair health,  should  take  up  problems  pertaining  to  exercise, 
sleep,  diet,  effect  of  mind  on  body,  emotional  control,  etc. 
The  subject  of  hygiene  should  be  presented  not  in  the  form 
of  fixed  "rules"  of  right  living  but  as  problems  of  right  living. 
After  all,  each  person  must  be  an  experimenter  to  a  certain 


THE   HYGIENE   OF   WOMEN' S  COLLEGES  613 

extent  regarding  his  own  health,  though  his  mode  of  experi- 
menting may  be  to  put  his  health  in  the  care  of  another 
person.  Hygiene  lectures  should,  therefore,  give  students  a 
knowledge  of  those  facts  which  have  been  definitely  proved 
by  physiologists  and  which  have  a  direct  bearing  on  health. 
The  lectures  should  consider  also  the  various  theories  of 
healthful  modes  of  living  to  give  students  some  idea  of  the 
difference  between  sound  and  false  physiological  proof.  Such 
a  course  can  be  made  sufficiently  scientific  and  sufficiently 
exacting  to  count  toward  an  A.B.  degree.  As  soon  as  a 
course  counts  toward  the  degree  it  assumes  importance  and 
hence  an  effectiveness  that  it  cannot  otherwise  possess. 
The  course  should  be  abundantly  supplemented  by  outside 
reading  and  should  include  questions  of  public  and  domes- 
tic sanitation.  The  freshmen  should  be  able  intelligently  to 
adapt  their  mode  of  life  to  their  physical  endurance  and  power. 

Also  free  and  abundant  opportunity  should  be  given  for 
the  students  to  consult  the  teacher  regarding  individual 
application  of  the  points  discussed  in  the  lectures.  This 
supplementary  work  would  tend  to  make  the  course  more 
effective  practically  and  to  lead  to  a  carrying  out  of  hygienic 
principles  in  the  life. 

But  the  attitude  of  the  college  toward  illness  must  be 
changed.  At  present,  if  a  student  is  ill,  she  is  taken  care  of 
and  "no  questions  asked."  She  is  not  made  sufficiently 
responsible.  Has  she  been  staying  up  late,  overeating  at 
tea-rooms,  underexercising,  or  committing  other  hygienic  in- 
discretions ?  If  she  has,  her  illness  should  be  treated  as  a  con- 
dition due  to  negligence  on  her  part,  and  if  such  conditions 
are  repeated  often  she  should  be  looked  upon  not  as  a  "deli- 
cate" girl  or  an  "unfortunate"  girl  but  as  an  "irresponsible" 
girl. 

Perhaps  some  girls  are  delicate,  are  unfortunate.  This 
possibility  is,  of  course,  always  to  be  borne  in  mind.  But  in 
general  the  average  young  girl  living  under  hygienic  con- 
ditions will  not  be  ill  unless  she  has  some  distinct  physical 


6 14  EDUCATIONAL   HYGIENE 

weakness,  and  that  bnn;^s  me  to  my  next  point.  No  obviously 
''delicate"  girls  should  be  admitted  to  the  regular  college 
course.  If  a  student  is  ill  or  weak,  in  such  a  way  as  to  make  it 
detrimental  to  her  to  carry  full  work  she  should  be  excluded 
on  the  basis  of  physical  disability  on  entrance. 

There  are  an  appreciable  number  of  students  who,  while 
not  "organically  unsound,"  suffer  constantly  from  ill  health, 
which  makes  it  necessary  for  them  to  miss  a  day  here  and  a 
day  there  and  later  to  work  late  at  night  to  ''catch  up"  in 
what  they  have  missed.  These  girls  require  extra  time  and 
thought  from  all  their  instructors  and  from  the  resident 
physician.  With  all  this  attention  they  often  partially  fail, 
necessitating  interviewing  by  the  dean  or  secretary  and  sub- 
sequently a  correspondence  between  college  and  parents. 
If  all  the  extra  time  devoted  to  such  students  were  counted 
up  it  would  amount  to  many  hours.  Also,  they  draw  upon 
the  sympathies  and  assistance  of  the  students  associated  with 
them.  And  what  do  they  themselves  gain  to  offset  this 
disproportionate  expenditure  of  energy?  Nothing  that  can 
compare  with  what  they  lose  in  the  necessary  neglect  of  health 
under  pressure  of  work.  The  unhealthy  student  must  devote 
a  larger  proportion  of  her  time  to  the  care  of  her  body  than  the 
healthy  student.  It  is  entirely  unjust  and  disadvantageous  to 
her  to  put  her  in  close  competition  with  those  physically  well. 

Exclusion  of  Physical  Weaklings. — Such  girls  should  be 
rigidly  excluded  from  our  colleges.  The  physical  weaklings 
are  in  a  large  proportion  of  cases  the  mental  weaklings,  not 
necessarily  because  their  brains  do  not  work  so  effectively,  but 
because  they  cannot  be  subjected  to  any  slight  extra  strain 
and  because  of  actual  classes  and  days  missed.  The  presence 
of  these  students  in  a  college  hampers  both  instructors  and 
other  students  and  cannot  possibly  be  justified  on  the  ground 
of  good  to  the  delicate  student.  The  latter  usually  needs  to 
pay  more  attention  to  getting  well  than  she  can  possibly  do 
while  striving  to  carry  work  which  is  planned  without  refer- 
ence to  the  constant  absences  necessitated  by  bad  physical 


TUK    HVC.IKNE   OF   WOMEN'S   COLLEGES  615 

condilions.  A  studciU  should  be  icjccled  on  the  basis  of  her 
physical  condition  at  the  discretion  of  the  examining  doctor. 

'i'his  regulation  was  not  necessary  in  the  early  days  of 
the  college,  because  the  pioneer  women  in  the  higher  education 
of  women  were  better  physical  specimens  than  the  more 
pampered  students  of  to-day.  In  addition  to  this  our  value 
of  health  as  a  business  and  .social  asset  has  increased.  If 
students  were,  then,  excluded  from  college  on  the  basis  of 
health,  the  standard  of  health  in  schools  would  be  raised.  A 
student  whose  health  is  distinctly  subnormal  is  a  student  who 
is  as  much  of  a  drag  as  a  badly  prepared  or  dull  student. 
This  does  not  mean  that  the  weakling  cannot  get  an  educa- 
tion. It  means  that  she  must  "get  well"  before  attempting 
average  mental  work.  It  is  often  the  misguided  ambitions 
of  the  parents  which  bring  the  physically  unfit  student  to 
college.  Would  not  the  parents  be  educated  most  rapidly 
by  being  forced  to  pay  more  attention  to  the  physical  well- 
being  of  their  children?  Only  in  this  way  can  a  standard  of 
health  which  shall  be  fair  to  the  well  students  and  the  faculty 
be  maintained. 

When  a  college  is  isolated  we  shall  always  have  an  in- 
firmary and  resident  physician.  When,  however,  the  college 
or  university  is  in  the  city,  a  health  ofHicer,  whose  function  is 
to  maintain  a  high  standard  of  health  and  an  rspril  de  corps 
regarding  it,  is  more  iiiii)()rt;iiit  than  a  resident  plnsician. 
'Vhc  emphasis  more  and  more  should  be  i)ut  on  physical 
education,  an  education  to  fit  the  student  to  meet  the  strain 
of  life  which  will  come  to  her  when  she  leaves  the  college. 

Summary.  -To  sum  up  briefly:  whiU'  we  are  paying  more 
and  more  attention  to  the  individual  student  in  the  women's 
colleges,  and  more  and  more  attention  to  sports  and  athletic 
interests  among  women,  we  have  been  too  tolerant  ot  the 
"delicate"  girl.  The  time  has  come  for  a  complete  change  of 
attitude  which  shall  eni|)hasi/e  (1)  the  right  of  the  student  to 
hygienic  conditions  in  its  broadest  sense  as  including  satis- 
factory mental  conditions,  and  (2)   the  responsibility  of  the 


6l6  EDUCATIONAL  HYGIENE 

student  for  her  own  physical  condition.  This  change  cannot 
be  brought  without  its  necessary  corollary,  the  refusal  on  the 
part  of  the  administration  to  receive  students  who  cannot, 
either  on  account  of  inheritance  or  bringing  up,  maintain  the 
high  standard  of  physical  excellence  the  woman's  college  must 
set  for  itself. 


CHAPTER  XXXIII 
THE  HYGIENE  OF  MEN'S  COLLEGES 

The  Health  Problem  and  Health  Provisions  of  Colleges. — 

The  large  place  occupied  by  physical  education,  hygiene,  and 
health  supervision  in  the  American  college  of  to-day  is  in 
marked  contrast  with  the  conditions  which  existed  fifty  years 
ago.  In  1855  President  Stearns,  of  Amherst  College,  wrote  in 
his  annual  report:  "No  one  thing  has  demanded  more  of  my 
anxious  attention  than  the  health  of  the  students.  The 
waning  of  the  physical  energies  in  the  midway  of  the  college 
course  is  almost  the  rule  rather  than  the  exception  among  us, 
and  cases  of  complete  breaking  down  are  painfully  numerous." 
Nothing  resulted  from  President  Stearns's  recommendations 
in  1855,  but  he  continued  to  advocate  the  matter  in  his  an- 
nual reports.  In  i860  he  wrote:  "What  we  need  is  a  pro- 
fessorship which  shall  extend  over  the  entire  department  of 
physical  education.  .  .  .  We  should  not  only  have  the  honor 
of  being  the  first  institution  in  the  country  which  has  ever 
sustained  such  a  professorship,  but  we  should  probably  save 
to  the  world  a  vast  amount  of  physical  and  mental  power 
which  would  otherwise  be  wasted."  On  August  6,  i860,  the 
Amherst  trustees  established  the  first  department  of  hygiene 
and  physical  education  in  a  college  and  appointed  a  physician 
as  professor  in  this  department. 

The  Amherst  plan  provided  a  regular  college  department 
to  control  prescribed  courses  in  physical  education,  voluntary 
athletics  organized  by  the  students,  courses  in  hygiene, 
medical  examinations  and  health  supervision  of  all  students, 
and  sanitary  supervision  of  dormitories  and  other  college 
buildings.     This  department,  wisely  conceived  and  organized 

617 


6l8  EDUCATIONAL  HYGIENE 

in  i860,  has  exerted  an  increasing  influence  for  good  up  to  the 
present  day.  It  is  surprising  that  Amherst's  successful  in- 
novation was  not  soon  followed  by  many  other  institutions, 
but  for  a  period  of  thirty  years  no  other  college  established  a 
department  of  hygiene  and  physical  education  as  complete 
as  the  one  at  Amherst.  Some  gymnasiums  and  athletic 
fields  were  built,  courses  in  gymnastics  and  hygiene  offered, 
and  a  few  colleges  provided  some  supervision  of  the  students' 
health,  but  these  activities  were  not  co-ordinated  in  a  single 
well-organized  department. 

Since  about  1890,  however,  colleges  have  made  such  rapid 
progress  in  this  direction  that  now  nearly  90  per  cent  have  de- 
partments of  physical  education  and  hygiene  representing  many 
different  forms  of  organization  and  degrees  of  efficiency.  In 
some  colleges  local  conditions  make  it  impracticable  to  organ- 
ize physical  education,  hygiene  instruction,  supervision  of  the 
students'  health,  and  sanitation  in  a  single  department,  but 
this  plan  is  the  most  economical  and  efficient  when  feasible. 

The  principles  of  organization,  scope,  present  status,  and 
tendencies  of  the  various  college  activities  for  the  physical 
education  and  welfare  of  students  may  be  considered  sepa- 
rately. 

Physical  Education. — Physical  education  includes  all 
forms  of  physical  exercise  engaged  in  for  health,  development, 
the  acquisition  of  physical  accomplishments,  and  recreation. 
The  physical  activities  carried  on  in  the  colleges  to-day  are 
usually  classified  in  two  groups,  termed  gymnasium  work  and 
athletics.  This  classification  is  the  result  of  the  peculiar  de- 
velopment of  these  two  general  forms  of  exercise  in  American 
colleges.  Gymnasium  work  owes  its  origin  to  the  recognition 
by  college  authorities  of  their  responsibility  for  the  physical 
welfare  of  students,  while  athletics  were  introduced  by  the 
students  in  response  to  the  natural  play  instinct  of  youth. 
Although  Harvard  College  built  a  gymnasium  in  1826  and  a 
few  other  institutions  provided  some  gymnasium  facilities 
between  1826  and  1830,  it  was  not  until  i860  that  depart- 


THE   HYGIENE   OF   MEN's   COLLEGES  619 

ments  of  physical  education  were  organized  on  a  permanent 
basis.  With  few  exceptions  the  physical  education  depart- 
ments organized  between  i860  and  1890  consisted  of  a  gym- 
nasium placed  in  charge  of  a  professional  trainer  without 
academic  rank  or  membership  in  the  college  faculty.  Gym- 
nasium work  was  optional  and  attracted  chiefly  the  strongest 
and  best-developed  students. 

Gradually  the  educational  value  of  systematic  physical 
training  was  recognized,  regular  courses  were  prescribed  for 
all  students,  and  in  many  colleges  positive  credit  toward  the 
bachelor's  degree  was  given  for  these  courses.  These  changes 
in  the  character  of  the  work  in  physical  education  demanded 
a  different  type  of  instructor,  with  the  result  that  the  pro- 
fessional trainers  of  the  early  period  were  replaced  by  college 
men  who  fitted  themselves  for  this  branch  of  education  and 
were  appointed  to  regular  positions  with  academic  rank  as  in 
other  subjects. 

The  growth  of  organized  physical  training  has  progressed 
with  such  rapidity  since  1890  that  now  over  98  per  cent  of 
the  colleges  have  gymnasium  facilities,  95  per  cent  offer 
regular  instruction  in  gymnastics,  and  over  87  per  cent  pre- 
scribe physical  education  for  graduation.  The  gymnasium 
director  has  a  seat  in  the  faculty  in  over  75  per  cent  of  the 
colleges  and  the  rank  of  professor  in  25  per  cent. 

The  amount  of  physical  education  prescribed  varies  con- 
siderably in  the  different  colleges.  About  half  require  two 
years,  about  one-quarter  require  only  one  year,  a  few  col- 
leges require  three  years,  and  15  per  cent  require  four  years. 
The  number  of  hours  required  per  week  varies  from  two  to 
five  hours,  the  great  majority  requiring  either  two  or  three 
hours. 

The  rapid  extension  in  the  number  of  colleges  offering  pre- 
scribed courses  in  physical  education  has  been  accompanied 
by  a  marked  change  in  the  character  of  the  work  taught. 
Prior  to  1900  physical  education  courses  consisted  chiefly  of 
marching,  drilling  with  dumb-bells,  wands,  and  Indian  clubs, 


620  EDUCATIONAL  HYGIENE 

and  exercises  on  the  heavy  gymnasium  apparatus  such  as 
horizontal  and  parallel  bars,  horse,  buck,  rings,  ladders,  and 
ropes.  Credits  for  these  courses  were  given  to  all  students 
who  attended  the  required  number  of  hours.  No  attempt 
was  made  to  establish  standards  of  proficiency  or  to  assign 
grades  based  on  examinations. 

The  period  since  1900  has  been  marked  by  extensive  and 
intensive  development  of  prescribed  courses  in  physical  edu- 
cation. The  number  of  colleges  offering  regular  courses  in 
this  subject  has  more  than  doubled;  the  scope  of  the  courses 
has  been  extended  to  include  swimming  and  all  forms  of 
athletics  and  games;  standards  of  proficiency  have  been  es- 
tablished and  methods  of  examination  and  grading  have  been 
adopted. 

In  those  institutions  where  the  work  has  reached  the  high- 
est degree  of  development  the  courses  are  organized  on  the 
following  basis: 

(i)  Aims. — The  courses  are  organized  to  accomplish  defi- 
nite objects. 

(a)  Health. — A  college  education  obtained  at  the  expense 
of  health  is  bought  too  dearly;  the  student  should  not  only 
maintain  his  health  during  his  college  course  but  increase  his 
strength,  vital  resistance,  and  capacity  for  hard  work.  Judi- 
cious, systematic  exercise  and  recreation  are  essential  to  ac- 
complish this  result. 

(b)  Bodily  Control. — Including  good  carriage,  graceful 
movement,  and  the  ability  to  handle  the  body  easily  and 
efficiently  in  all  the  circumstances  of  every-day  life.  This 
implies  ability  to  handle  the  body  on  the  ground,  as  in  walk- 
ing, running,  and  jumping  over  obstacles;  off  the  ground,  as  in 
climbing  and  other  methods  of  handling  the  body  by  the  arms; 
in  the  water,  as  in  swimming. 

(c)  Physical  Accomplishments. — This  does  not  imply  gym- 
nastic or  athletic  skill  for  purposes  of  competition,  but  a  knowl- 
edge of  many  forms  of  exercise  which  may  be  kept  up  for 
health  and  recreation  after  graduation.     Personal  habits  and 


U 

42 


ai     '-J 


"i    6 


TH£    HYGIENE    OF    MENS   COLLEGES  621 

skill  in  neuro-muscular  .univitios  must  bo  acquired  durinu 
youth;  men  r.vrely  form  habits  of  exercise  and  acquire  skill 
in  games  after  the  age  of  twenty-rive. 

■d^  HyiUrtk  Lii^in^^.—Jhis  implies  a  knowledge  of  the 
principles  of  personal  hygiene  and  sanitation.  The  student 
who  has  learned  these  principles  is  competent  to  regulate  his 
habits  of  diet.  work.  rest,  ba tiling,  and  exercise,  and  to  dis- 
charge his  duties  a>.  a  citizen  in  matters  of  public  hygiene  and 
sanitation. 

:'  Contents  of  Physical  Education  Courses. — The  courses 
usualh'  include  g\Tnnastic^.  athletics,  games,  swimming,  and 
hygiene.  The  tendency  during  the  past  few  years  has  been  to 
teach  less  of  formal  g\^nnastics  and  more  of  atldetics  and 
games.  This  change  accomplishes  two  objects:  it  a^ords  a 
much  bro.i  "  ^re  interesting  curriculum  and  makes 

possible  a  c.:...  ,  ^^  v.nt  of  outdoor  exercise  which  is  always 
more  benericial  than  indoor  work.  Where  the  climate  per- 
mits, a  large  prop'^"'  :'  the  work  is  carried  on  outdoors. 
Athletics  and  game-  ways  more  interesting  than  formal 

gymnastics,  and  for  that  reason  there  is  a  tendency  in  some 
institutions  to  give  up  gymnastics  altogether.  There  are 
govxi  reasons,  however,  for  believing  that  rational  gymnastics 
will  continue  to  be  accorded  a  place  in  all  coiiiplete  and  well- 
balanced  physical  education  courses.  The  particular  advan- 
tages of  gymnastics  are:  .: "  adaptability  to  individual  needs 
by  judicious  selection  of  movements  to  accomplish  definite 
objects  such  as  improving  posture,  developing  a  flat  chest, 
strengthening  abdominal  walls,  regulating  dosage  of  exercise  to 
strengthen  the  heart,  etc.  .^^  By  means  of  g>-mnastics  large 
numbers  of  students  can  be  handled  in  a  room  which  would 
accommodate  onl>-  ten  students  in  basket-ball  or  other  games. 
.'  Gymnastics  exercise  is  available  in  bad  weather  when 
practically  no  outdoor  exercise  is  feasible  on  account  of 
rain.  snow.  mud.  or  extremely  cold  weather.  Furthermore, 
manv  believe  that  fundamental  bodily  training  in  posture. 
audlitv.  and  abilitv  to  handle  the  body  under  all  circumstances 


622  EDUCATIONAL   HYGIENE 

of  every-day  life  can  be  accomplished  better  by  gymnastics 
than  any  other  form  of  exercise.  Dancing  (esthetic  and  folk 
dancing  as  distinguished  from  social  dancing)  is  gaining 
rapidly  in  popularity  as  a  form  of  gymnastics.  By  a  judicious 
selection  of  the  more  vigorous  steps  and  proper  adaptation 
dancing  can  be  made  a  most  valuable  part  of  a  rational  sys- 
tem of  physical  education  for  men.  Dancing  excels  all  forms 
of  exercise  as  a  means  of  developing  bodily  control  and  ex- 
pression.^  The  inclusion  of  swimming  in  prescribed  physical 
education  courses  is  a  recent  development.  It  is  required  in 
about  1 6  per  cent  of  the  colleges.  There  is  a  growing  tendency 
to  include  some  didactic  instruction  in  hygiene  as  a  regular 
part  of  the  physical  education  courses.  In  some  colleges  this 
instruction  is  given  during  the  first  ten  or  fifteen  minutes  of 
the  physical  training  period,  but  in  most  institutions  a  regular 
course  of  one  or  two  hours  a  week  is  offered. 

(3)  Standards  of  Proficiency,  Examinations,  and  Grades i. 
(a)  Having  accorded  a  place  to  physical  education  in  the  col- 
lege curriculum,  it  is  essential  to  establish  standards  of  pro- 
ficiency which  must  be  attained  by  the  students  who  are  to 
receive  credit  for  this  work.  Granted  a  rational  and  well- 
balanced  course  and  good  instruction,  the  student  who  has  at- 
tended regularly  and  worked  faithfully  should  possess  health, 
bodily  control,  good  posture,  a  knowledge  of  many  forms  of 
exercise,  including  athletic  games  and  swimming,  and  a  knowl- 
edge of  the  principles  of  hygiene  and  sanitation. 

(b)  Examinations  are  intended  to  measure  the  degree  of 
proficiency  attained  in  so  far  as  proficiency  is  measurable. 
While  health  is  an  important  aim  in  physical  education  it  rs 
not  easily  measured.  It  may  therefore  be  assumed  that  the 
student  who  has  taken  a  course  in  physical  education  has 
acquired  at  least  a  fair  degree  of  health  and  vigor.  Bodily 
control,  posture,  skill  in  games  and  swimming,  and  knowledge 
of  hygiene  and  sanitation  arc  measurable  by  means  of  tests. 

'  Among  the  ancient  Greeks  dancing  was  considered  one  of  the  most  valuable 
forms  of  general  physical,  mental,  and  cultural  education. 


3      i3 


THE   HYGIENE   OF   MEn's   COLLEGES  623 

Marks  are  assigned  for  proficiency  and  students  graded  as  in 
other  subjects  in  the  college  curriculum. 

Care  of  the  Student's  Health,  Medical  Supervision. — 
The  American  college  is  taking  a  prominent  place  in  the  van 
of  the  general  movement  for  the  conservation  of  life  and  health. 
The  assembhng  of  hundreds  or  thousands  of  students  and 
teachers  in  the  college  community  presents  problems  of  public 
health  not  unlike  those  of  a  town  or  city  of  the  same  size. 
These  have  to  do,  for  example,  with  the  discovery,  investi- 
gation, isolation,  and  prompt  treatment  of  all  cases  of  in- 
fectious disease,  and  the  taking  of  prophylactic  measures, 
such  as  vaccination,  etc.,  for  the  prevention  of  epidemics.  In 
cases  of  illness  or  accident  the  students  living  in  college  dor- 
mitories, fraternity  houses,  and  private  houses  are  dependent 
upon  their  student  friends  for  help  and  advice  unless  the  col- 
lege provides  medical  supervision.  In  colleges  where  medical 
supervision  is  thoroughly  organized  it  includes:  (i)  periodical 
medical  examinations  of  all  students;  (2)  medical  and  surgical 
treatment  in  emergency  cases;  (3)  daily  office  hours  by  a 
physician  for  (a)  consultation,  (b)  treatment  of  minor  ail- 
ments, (c)  receiving  reports  from  students  who  are  confined  to 
their  rooms  by  illness;  (4)  provision  for  treatment  of  medical 
and  surgical  cases  either  in  an  infirmary  maintained  by  the 
college  or  in  a  local  hospital. 

Only  10  per  cent  of  American  colleges  have  organizations 
covering  all  these  four  phases,  but  nearly  all  of  them  provide 
some  medical  supervision,  as  shown  by  the  following  figures: 
80  per  cent  provide  periodical  medical  examination  of  stu- 
dents; 57  per  cent  provide  medical  and  surgical  treatment; 
26  per  cent  provide  medical  and  surgical  treatment  in  emer- 
gencies only;  46  per  cent  provide  for  medical  consultations 
and  advice,  but  without  treatment. 

The  periodical  medical  examination  of  students  is  the 
most  wide-spread  feature  of  medical  supervision.  These  ex- 
aminations are  in  nearly  all  cases  given  in  the  department  of 
physical  education  and  required  of  all  new  students.     One 


624  EDUCATIONAL  HYGIENE 

or  more  subsequent  examinations  are  required  in  8i  per  cent 
of  the  colleges  and  optional  in  the  others. 

The  chief  purpose  of  these  medical  examinations  is  to 
ascertain  the  physical  condition  of  each  student,  record  all 
physical  defects,  prescribe  or  suggest  treatment  for  such 
defects,  and  advise  the  student  in  matters  of  diet,  exercise, 
rest,  bathing,  etc.,  with  a  view  to  improving  his  health  and 
efficiency. 

Physical  Defects  Found. — The  importance  of  making 
periodical  medical  examinations  of  college  students  is  shown 
by  the  results  obtained.  The  following  table  shows  a  resume 
of  the  physical  defects  found  in  five  hundred  college  students: 

PER   CENT 
HAVING   DEFECT 

Eyesight,  right  eye 56 

Eyesight,  left  eye 52 

Hearing,  right  ear 9.8 

Hearing,  left  ear 9.6 

Heart 21 

Lungs 18.2 

Nasal  fossae,  right 19 

Nasal  fossae,  left 24 . 4 

Teeth 64 . 8 

Pharynx 46 

Tonsils 19.2 

Skin 28 

Head  (carried  forward) 57.6 

Spine 92-4 

Shoulders 44. 2 

Chest 30-4 

Abdomen 48.8 

Hernia 2.2 

Legs 24.6 

Feet 48 . 8 

General  condition  below  normal 13 

No  charge  is  made  for  medical  supervision  except  in  col- 
leges which  maintain  an  infirmary;  in  these  institutions  it 


iu:ninn.vrjii:::mz:: 


Sladiuni  for  the  athletic  field  shown  below 

It  has  been  placed  at  the  west  end  of  the  field  in  front  of  the  Orphan  Asylum  in  the 
background 


Secondary  school  and  gymnasium  of  the  College  of  the  City  of  New  York 

on  right 
The  stadium  shown  above  has  been  erected  on  this  field 


THE  HYGIENE  OF  MEN's  COLLEGES       625 

is  customary  to  charge  an  annual  fee  of  three  to  ten  dollars 
to  all  students,  which  fee  entitles  them  to  treatment  and 
nursing.  In  some  colleges  an  extra  charge  is  made  for  board 
at  the  infirmary;  in  others  the  annual  fee  entitles  the  student 
to  board  for  only  a  limited  period.  In  cases  of  serious  or 
protracted  illness  or  surgical  operations  it  is  custom.ary  to 
charge  the  student  for  medical  services  and  nursing. 

There  is  a  growing  tendency  for  colleges  to  assume  more 
and  more  responsibility  for  the  care  of  students'  health  in  its 
various  phases.  A  competent  physician  who  gains  the  con- 
fidence of  the  students  can  do  an  incalculable  amount  of  good, 
not  only  by  ministering  to  their  physical  health,  but  by  guid- 
ing and  advising  them  in  many  matters  which  affect  their 
moral  welfare. 

Two  important  phases  of  medical  supervision  which  alone 
justify  the  expenditure  of  a  physician's  salary  are:  (i)  the 
early  detection  and  isolation  of  cases  of  infectious  diseases, 
thus  preventing  the  development  of  epidemics  in  the  college 
community;  (2)  the  regulation  of  students'  absence  from  col- 
lege exercises  on  account  of  illness;  all  such  absences  should 
be  excused  only  by  the  college  physician. 

Sanitary  Inspection  of  Buildings  and  Grounds. — Another 
important  phase  of  college  hygiene  is  the  sanitary  inspection 
of  the  buildings  and  grounds,  and  proper  supervision  of  the 
water  supply,  sewage  disposal,  etc.  The  rapid  growth  of 
college  communities  during  the  past  twenty-five  years  and 
the  wonderful  progress  made  in  the  science  of  sanitation  dur- 
ing the  same  period  make  necessary  a  definite  organization 
in  every  college  for  sanitary  inspection  and  supervision. 

About  80  per  cent  of  the  colleges  have  some  form  of  sys- 
tematic inspection;  the  responsibility  is  delegated  to  different 
officers  or  members  of  buildings  and  grounds  committees. 
In  75  per  cent  of  the  colleges  the  inspection  is  made  by  a 
college  officer  (usually  the  director  of  the  gymnasium  or  the 
superintendent  of  buildings  and  grounds)  either  as  an  individ- 
ual responsible  to  the  trustees  or  as  a  member  of  a  committee; 


626  EDUCATIONAL   HYGIENE 

in  the  other  25  per  cent  the  inspection  is  made  by  city  or  State 
officials.  Here,  again,  there  is  a  tendency  to  correlate  this 
branch  of  hygiene  with  the  activities  of  the  department  of 
physical  education  and  the  care  of  the  students'  health  in 
charge  of  a  medically  trained  director. 

Sanitary  inspection  in  a  college  community  includes  the 
following : 

(i)  Inspection  of  heating,  ventilation,  lavatories,  and  clean- 
ing of  buildings  used  for  administration,  recitation,  labora- 
tories, etc. 

(2)  Inspection  of  heating,  ventilation,  cleaning,  lavatories, 
and  baths  in  dormitories. 

(3)  Inspection  of  dining-room,  kitchen,  refrigerators,  milk 
and  food  supply,  and  waste  disposal  in  commons  or  restaurant. 

(4)  Inspection  of  gymnasium,  dressing-rooms,  baths,  lav- 
atories, and  swimming-pool. 

(5)  Inspection  of  water  supply. 

(6)  Inspection  of  sewage  and  waste  disposal. 

(7)  Advice  in  planning  new  buildings  and  remodelling  old 
ones. 

Hygiene  Instruction. — Hygiene  appears  in  the  list  of  sub- 
jects taught  in  colleges  as  early  as  1850,  but  very  few  of  the 
institutions  which  offered  instruction  in  this  subject  prior 
to  1900  gave  it  academic  recognition  by  requiring  it  for  gradu- 
ation or  counting  it  as  a  credit  toward  the  bachelor's  degree. 
In  most  cases  nothing  more  was  attempted  than  to  offer  a  few 
lectures  on  personal  hygiene;  attendance  was  optional;  there 
were  no  examinations  and  no  credits.  The  growing  interest 
in  health  conservation  and  the  rapid  progress  made  in  hygiene 
in  all  its  branches  have  brought  about  the  recognition  of  this 
subject  as  essential  in  the  college  curriculum.  Physical  edu- 
cation, medical  supervision  of  students'  health,  and  college 
sanitation  are  all  valuable  in  protecting  students'  health  and 
giving  them  practical  instruction  in  healthful  living,  but  these 
activities  should  be  supplemented  by  some  definite  instruction 
in  the  principles  of  hygiene  and  sanitation. 


THE   HYGIENE   OF   MEN's   COLLEGES  627 

Prior  to  1900  only  36  per  cent  of  the  colleges  offered  courses 
in  hygiene,  whereas  in  1914  more  than  90  per  cent  offered  one 
or  more  courses  in  this  subject.  The  tendency  is  to  include 
some  hygiene  instruction  in  the  prescribed  physical  education 
courses  as  previously  described  in  this  chapter.  In  76  per 
cent  of  the  colleges  where  hygiene  is  taught  the  subject  is  re- 
quired for  graduation. 

The  topics  most  frequently  included  in  the  prescribed 
courses  are:  health,  heredity,  and  environment;  the  modern 
theory  of  disease;  the  role  of  air,  water,  animals,  and  man  in 
the  transmission  of  disease;  the  factors  in  disease  prevention; 
vital  resistance,  immunity,  isolation,  cleanliness,  disinfection; 
hygiene  of  nutrition,  beverages,  exercise,  excretion  (lungs, 
intestines,  kidneys,  skin) ;  nervous  system  (hygiene  of  mind, 
work,  recreation,  sex),  eyes,  teeth,  etc.;  first  aid. 

Elective  courses  are  offered  in  some  large  universities  cov- 
ering such  specialized  branches  as  industrial  hygiene,  vital 
statistics  and  social  economics,  sanitary  inspection,  and  pub- 
lic health  administration. 

If  our  colleges  are  to  help  the  people  of  our  country  to 
solve  most  effectively  the  principal  problems  of  life,  they  will 
emphasize,  far  more  than  at  present,  thoroughgoing  health 
education  of  all  students.  Through  adequate  medical  super- 
vision, through  careful  supervision  of  sanitation,  through 
physical  education  for  all  students,  and  through  the  practical 
and  scientific  teaching  of  health  knowledge,  health  habits, 
and  health  ideals,  health  and  normal  physical  development 
will  be  provided  for  an  important  part  of  our  population. 


BIBLIOGRAPHY 

I.     BOOKS 

Adams:  "  The  Health  Master."     (Houghton,  Mifflin.) 
Allen,  W.  H.:   "Civics  and  Health."     $1.25.     (Ginn.) 

:  "Woman's  Part  in  Government."    $1.50.     (Dodd,  Mead.) 

Angell,  E.  D.:  "Play." 

Ayres,  L.  P.:  "Open  Air  Schools."     (Doubleday,  Page  &  Co.) 

:   "Laggards  in  Our  Schools." 

Bancroft:    "Games."     (Macmillan.) 

:  "The  Posture  of  School  Children."     (Macmillan.) 

Barr,  M.:   "Mental  Defectives." 

Barry,  W.  F.:    "The  Hygiene  of  the  Schoolroom."    $1.50.     (Silver, 

Burdett.) 
Bergey,  D.  H.:   "The  Principles  of  Hygiene."    $3.00.     (Saunders.) 
Bloomfield,   M.:  "Youth,   School,  and  Vocation."    $1.25.     (Hough- 
ton, Mifflin.) 
Bluemel:   "Stammering  and  Cognate  Defects  of  Speech." 
Bryant:   "School  Feeding."    $1.50.     (Lippincott.) 
Burgerstein,  L.:   "Schulhygiene."     (B.  G.  Teubner,  Leipzig.) 

:  "  School  Hygiene,"  translation  published  by  F.  A.  Stokes  Co. 

Burks,  F.  W.  and  J.  D.:  "Health  and  the  School."     Appleton. 
Burrage  and  Bailey:    "School  Sanitation  and  Decoration."    $1.50. 

(Heath.) 
Cabot,  E.  L. :  "  Volunteer  Work  in  the  Schools."     (Houghton,  Mifflin.) 
Chisholm,  C:  "The  Medical  Inspection  of  Girls  in  Secondary  Schools." 

(Longmans.) 
Coleman:   "The  People's  Health."     (Macmillan.) 
Cornell,  W.  S.:  "Health  and  Medical  Inspection  of  School  Children." 

$3.00.     (F.  A.  Davis  Co.) 
Crowley,  R.  H.:    "The  Hygiene  of  School  Life."     (Methuen  &  Co., 

London.) 
Cruickshank,  L.  D.:    "School  Clinics."     (The  National  League  for 

Physical  Education  and  Improvement,  London.) 
Curtis,  S.  H.:  "Education  through  Play."     (Macmillan.) 

:   "Play  and  Recreation  for  the  Open  Country."     (Ginn.) 

:   "The  Practical  Conduct  of  Play."     (Macmillan.) 

629 


630  BIBLIOGRAPHY 

Davenport,    C.    B.:     "Heredity    in    Relation    to    Eugenics."     $2.00. 

(Holt.) 
Denison,  Elsa:   "Helping  School  Children."     $1.40.     (Harper.) 
Dillaway:    "  Decoration  of  the  School  and  Home."     (Milton  Bradley 

Co.) 
Ditman,  N.  E.:  "Home  Hygiene  and  the  Prevention  of  Disease." 

$1.50.     (Duffield.) 
Doty,  A.  H.:   "Prompt  Aid  to  the  Injured." 
Dresslar,  F.  B.:    "School  Hygiene."     $1.25.     (Macmillan.) 
Ellis,  H.:    "The  Task  of  Social  Hygiene."     (Houghton,  Mifflin.) 
Ellwood,  C.  A.:    "Sociology  and  Modern  Social  Problems."     $1.00. 

(American  Book  Co.) 
Emerson,  C.  P.:    "Essentials  of  Medicine."     $2.00.     (Lippincott.) 
Fisher,  Irving:   "National  Vitality." 

Fitz,  G.  W.:  "Principles  of  Physiology  and  Hygiene."     $1.12.     (Holt.) 
Forsythe:   "Children  in  Health  and  Disease." 
Foster,  W.  T. :   "The  Social  Emergency."     (Houghton,  Mifflin.) 
Gerhard,  W.  P.:    "Sanitation  of  Public  Buildings."     (Wiley  &  Sons, 

London.) 
Gillette,  J.  M.:   "Constructive  Rural  Sociology."     $2.00.     (Sturgis  & 

Walton.) 
Gulick,  L.  H.:   "The  Healthful  Art  of  Dancing." 
Gulick   and  Ayres:    "Medical  Inspection  of   Schools,   1913."     (The 

Survey  Associates.) 
Gulick  and  Jewett:   The  Gulick  Hygiene  Series. 
Guthrie:   "Functional  Nervous  Diseases  of  Children." 
Hall,  G.  S.:  "Adolescence."     $7.50.     (Appleton.) 

:   "Youth."     (Appleton.) 

Hall,    W.    S.:     "Sexual    Knowledge."     $1.00.     (International    Bible 

House.) 
Hamilton,  C:   "The  Blindness  of  Virtue." 
Hart,  H.  H.:   "Preventive  Treatment  of  Neglected  Children." 
Hoag:   "Concerning  Children." 
Hoag,  E.  B.:    "The  Health  Index  of  Children."     (Whitaker  &  Ray- 

Wiggin  Co.) 

:   "Health  Studies."     60  cents.     (Heath.) 

Hoag  and  Terman:    "Health   Work  in   the   Schools."     (Houghton, 

Mifflin.) 
Hofer,  M.:  "  Folk  Games  and  Dances." 

Hogarth,  A.  H.:   "Medical  Inspection  of  Schools."     (Oxford  Univer- 
sity Press,  London.) 
Holmes,  A.:   "The  Conservation  of  the  Child." 
:   "School  Organization  and  the  Individual  Child." 


BIBLIOGRAPHY  63 1 

Holt,  E.:  "Diseases  of  Childhood  and  Infancy."     (Applcton.) 

Hough  and  Sedgwick:   "The  Human  Mechanism."     $2.00.     (Ginn.) 

Huey,  E.  B.:   "Backward  and  Feeblc-Minded  Children." 

Hutchinson,  W.:   Health  Series.     (Houghton,  Mifflin.) 

:  "Handbook  of  Heahh."     $65.00. 

Jewett,  F.  G.:  "The  Next  Generation."     (Ginn.) 

Kelynack,  T.  N.:  "Medical  Examination  of  Schools  and  Scholars." 
(King,  London.) 

Lapage:    "Feeblemindedness  in  Children  of  School  Age." 

Lee:   "  Play  in  Education."      (Macmillan.) 

Leland,  A.:  "Playground  Teaching  and  Playcraft."     $2.70. 

Lippert  and  Holmes:  "When  to  Send  for  the  Doctor."     (Lippincott.) 

McCombs,  R.  S.:  "Diseases  of  Children  for  Nurses."  $2.00.  (Saun- 
ders.) 

Mackenzie,  W.  L.:  "The  Health  of  the  School  Child."  (Methuen, 
London.) 

McKenzie,  T.:    "Physical  Education." 

Mangold,  G.  B.:   "Child  Problems."     $1.25.     (Macmillan.) 

Marshall,  J.  S.:    "Mouth  Hygiene."     $1.50. 

Mero:    "American  Playgrounds." 

MoU,  A.:  "The  Sexual  Life  of  the  Child."    fi.75.     (Macmillan.) 

Monroe,  P.:  "Cyclopedia  of  Education."  5  vols.  $25.00.  (Mac- 
millan.) 

Nissen:   "Swedish  Gymnastics." 

Nutting,  Read,  and  Stuart:  "The  Nurse  in  Education."  $75.00. 
(The  University  of  Chicago  Press.) 

Oppenheim:   "The  Care  of  the  Child  in  Health." 

O'Shea,  M.  V.,  and  Kellog,  J.  H.:  Health  Series.     (Macmillan.) 

Perry,  C.  A.:  "Wider  Use  of  the  School  Plant."  $1.25.  (Charities 
Publication  Committee.) 

Rapeer,  L.  W.:  "The  Administration  of  School  Medical  Inspection." 
50  cents.     (Teachers  College  Publication  Department.) 

:   "School  Health  Administration."     (Out  of  print.) 

:   "School  Health,  a  Handbook."     (Heath.     In  preparation.) 

Richards:    "Hygiene  for  Girls."     (Heath.) 

Ritchie,  J.  T.:    Hygiene  Series.     (World  Book  Co.) 

Rosenau:  "Preventive  Medicine  and  Hygiene."     (Appleton.) 

Sandiford,  P.:   "Mental  and  Physical  Life  of  School  Children." 

Sargent,  D.:    "Physical  Education." 

School  of  Civics  and  Philanthropy,  Chicago.  "The  ChUd  in  the 
City." 

Schubert:  "Das  Schulartzwesen  in  Deutschland."     (Voss,  Hamburg.) 

Scripture:   "Stuttering  and  Stammering." 


632  BIBLIOGRAPHY 

Seller:   "  Handbuch  dcr  Deutschen  Schulhygiene."     $9.00.      (Stein- 

kopff,  Dresden  and  Leipzig.) 
Shaw,  E.  R.:    "School  Hygiene."     $i.cx).     (Macmillan.) 
Sill,  E.  M. :    "The  Child — Its  Care,  Diet,  and  Common  Ills."    40 cents. 

(Holt.) 
Stecher,  W.  A.:   "German-American  System  of  Gymnastics." 
Steven,  E.  M.:  "Medical  Supervision  of  Schools."    (Bailliere,  London.) 
Still:   "The  Common  Disorders  and  Diseases  of  Childhood." 
Struthers,  L.  N.:    "The  School  Nurse."     (In  preparation.) 
Terman,    L.    M.:     "The    Teacher's    Health."     $60.00.     (Houghton, 

Mifflin.) 

:  "The  Hygiene  of  Instruction."     (In  preparation.) 

:  "The  Hygiene  of  the  School  Child."     (Houghton,  Mifflin.) 

Tolman,  W.  H.:   "Hygiene  for  the  Worker."     (American  Book  Co.) 

Tredgold,  A.  P.:   "Mental  Deficiency." 

Tuley:    "The  Diseases  of  Children."     (Mosby.) 

Wallace,  A.  R.:   "Social  Environment  and  Moral  Progress." 

Wallin:    "Mental  Health  of  the  School   Child."     (Yale  University 

Press.) 
:    "Experimental  Studies  of  Mental  Defectives."      (Warwick  & 

York.) 
Ward,  E.  J.:    "The  Social  Center."     (Appleton.) 
Weeks,  A.  D.:   "The  Education  of  Tomorrow."     (Sturgis  &  Walton.) 
Whipple:   "Manual  of  Mental  and  Physical  Tests." 
Whitmer,  L.:    "Special  Class  for  Backward  Children." 
Wile,  I.:    "Sex  Education."     (Duffield.) 
Willson,  R.  N. :   "Education  in  Sex  Hygiene." 
Wood,  T.  D.:     "Health  and  Education."     75  cents.     (University  of 

Chicago  Press.) 

:  "School  Sanitation."     (In  preparation.) 

Woodworth,  R.  S.:   "The  Care  of  the  Body."     $1.50.     (Macmillan.) 

II.    REPORTS    AND    MAGAZINES 

Annual  Reports  of  the  Chief  Medical  Officer  of  the  English  Board 

of  Education,  Whitehall,  London. 
Annual  Reports  of  Cities  Having  Medical  Supervision. 
Bulletins  of  the  Russell  Sage  Foundation. 

Bulletins  of  the  U.  S.  Bureau  of  Education  and  the  Annual  Reports. 
Proceedings  of  the  Fifteenth  International  Congress  on  Hygiene  and 

Demography. 
Proceedings  of   the  National   School   Hygiene   Association.     Doctor 

T.  L.  Storey,  New  York,  Sec. 


BIBLIOGRAPHY  633 

Proceedings  of  the  International  Congress  on  School  Hygiene,  es- 
pecially the  Fourth,  Secretary  as  above. 

Proceedings  of  the  National  Education  Association. 

Proceedings  of  the  National  Playground  Association, 

Proceedings  and  Journal  of  the  American  Medical  Association. 

Report  of  the  School  Medical  Olificer,  Dunfermline,  Scotland. 

Reports  of  the  Chief  Medical  Ofl&cer  of  the  Board  of  Education  of 
Scotland,  Edinburgh. 

Reports  of  the  Chief  Medical  Officers  of  Bradford,  Cambridge,  London, 
etc.,  of  England. 

Volumes  of  The  American  Physical  Education  Review. 

Volumes  of  The  Playground  Magazine. 

Volumes  of  The  Psychological  Clinic. 

Volumes  of  Zeiischrift  fur  Schulgesundheit. 

Extensive  bibliographies  and  lists  of  bulletins  obtainable  from  the 
U.  S.  Bureau  of  Education. 

Bibliography  on  educational  hygiene,  published  by  Teachers  College, 
Columbia  University. 

Many  of  the  popular  magazines,  especially  The  Popular  Science 
Monthly,  and  most  of  the  educational  magazines  now  publish 
articles  on  various  phases  of  educational  hygiene. 

The  surveys  of  many  cities  and  States  or  parts  of  States  have  sec- 
tions devoted  to  educational  hygiene;  e.  g.,  the  Portland,  Ore., 
the  Springfield,  111.  (Russell  Sage  Foundation),  the  Ohio,  the 
Pennsylvania,  Wisconsin,  Butte,  Mont.,  etc. 

Some  of  the  most  helpful  bulletins  of  the  U.  S.  Bureau  of  Education. 
Along  this  line  are  those  on  rural  schoolhouses  and  grounds,  open- 
air  schools,  the  health  of  school-children,  sanitary  surveys  in 
several  parts  of  the  country,  school  architecture,  bibliographies, 
exceptional  children,  consolidation  of  schools,  the  Gary  system  of 
education,  and  digests  of  school-health  literature,  etc. 

Bulletins  of  the  Smithsonian  Institution,  such  as  Hill's  "  The  Relation 
of  the  Atmosphere  to  Our  Health." 

U.  S.  Mortality  Statistics. 

Reports  and  bulletins  of  U.  S.  Public  Health  Service. 

Bulletins  and  reports  of  several  State  boards  of  health,  c.  g.,  New 
York. 

Bulletins  of  several  city  boards  of  health,  e.  g.:  Providence,  R.  I.; 
Cincinnati,  Ohio;   and  New  York  City. 

Bulletins  of  several  life-insurance  companies,  and  of  the  Life  Extension 
Institute  of  America. 


APPENDICES 

APPENDIX   I 

HEALTH  AND  SCHOOL  PROGRESS 

The  Relation  of  Health  to  Economy  in  Education  and  to 
Physical  and  Mental  Progress 

All  persons  realize  that  there  is  some  general  relationship  between 
health  and  ability  to  study  and  to  progress  in  school  activities.  We 
find  some  children,  however,  who  seem  to  be  in  rather  feeble  health 
or  who  have  physical  defects  that  would  seemingly  hinder  them 
seriously  in  their  school  work,  but  who,  nevertheless,  make  fair  or 
superior  progress  in  their  studies.  That  this  is  not  a  general  rule  we 
are  from  the  facts  fairly  sure,  and  that  such  children  may  succeed  in 
school  at  the  cost  of  future  vitality  and  normal  physical  development 
is  certain.  But  just  what  the  correlation  is  must  be  determined  by 
scientific  investigations  of  a  medical,  pedagogical,  psychological,  and 
statistical  character.  Some  of  the  principal  questions  which  confront 
us  in  this  important  field  are  as  follows: 

1.  How  much  of  non-promotion,  retardation,  elimination,  and  other 
phases  of  school  pathology  are  due  to  the  ailments  and  defects  of 
pupils  ? 

2.  What  ailments  or  defects  seem  to  be  closely  correlated  with 
school  failure  or  inefficiency? 

3.  What  ailments  and  defects  seem  to  have  little  or  no  bad  effect 
on  school  progress?     On  physical  development? 

4.  What  ailments  and  defects  of  teachers  are  correlated  with 
teaching  inefficiency? 

5.  What  is  the  relationship  of  absence  due  to  ill  health  to  pupil 
inefl&ciency  ? 

6.  What  are  the  effects  of  cures  and  corrections  of  ailments  and 
defects  on  pupil  or  teacher  efficiency? 

7.  To  what  extent  does  the  degree  of  defect  or  seriousness  of  an 
ailment  correlate  with  pupil  efficiency? 

8.  What  is  the  correlation  between  ailments  and  defects  in  school 
life  and  early  death? 

g.  What  is  the  relation  of  certain  sanitary  improvements  to  school 
progress  of  pupils? 

63s 


636  APPENDIX   I 

10.  Do  schools  which  have  all-round  and  thoroughgoing  educa- 
tional hygiene  prove  in  any  educational  ways  superior  to  others  not 
having  such  provisions? 

The  principal  summaries  of  investigations  in  this  field  are  to  be 
found  in  Gulick  and  Ayres's  "Medical  Inspection  of  Schools"  and 
Rapeer's  "School  Health  Administration"  (out  of  print).  "The  Re-a 
lation  of  Health  to  School  Progress  "  would  at  this  time  be  an  admirable'^ 
problem  for  a  doctor's  dissertation.  Not  only  to  provide  arguments 
for  the  extension  of  educational  hygiene  in  schools  but  as  a  means  of 
better  scientific  control  of  the  educative  process,  such  investigations 
have  much  of  value  to  offer.  In  the  briefest  manner  possible  and  with 
little  critical  comment  we  consider  it  desirable  to  record  here  several 
investigations  and  the  results  reached.  First  are  given  summaries  of 
data  ofltered  by  Gulick  and  Ayres. 

Doctor  Cornell  found  among  1,594  children  in  five  schools  that 
but  28.8  per  cent  of  the  "exempt,"  or  passed-without-examination, 
pupils  were  physically  defective,  while  of  those  with  less  satisfactory 
scholarship,  the  non-exempt,  38.1  per  cent  were  defective.  Of  course, 
we  may  account  for  this  difference  in  scholarship  in  relation  to  phys- 
ical defects  on  the  ground  that  the  children  with  a  greater  percentage 
of  physical  defects  and  ailments  had  poorer  home  conditions  and 
possibly  poorer  heredity  as  a  basis  for  school  work.  Reavis  and 
others  have  shown  that  there  is  a  fairly  close  correlation  between 
poor  conditions  for  home  study  and  poor  scholarship,  and  several 
studies  show  that  the  grosser  physical  defects  and  ailments  are  more 
common  among  pupils  with  poor  home  conditions.' 

Doctor  Newmayer  also  found  the  percentage  of  cases,  among  5,005 
exempt  and  non-exempt  pupils,  50  for  the  first  and  66  for  the  second 
group.  The  actual  percentage  differences  for  the  two  groups  in  eight 
classes  of  defects  are  surprisingly  slight,  and  the  correlation  here  could 
be  partly  accounted  for  on  other  grounds  than  the  defects. 

Superintendent  Bryan  in  1906  compared  the  percentages  of  hearing 
and  vision  defects  of  pupils  retarded  in  the  schools  with  the  percent- 
ages of  those  who  were  not.  There  were  8,110  normal  children  and 
2,020  retarded.  The  retarded  had  50  per  cent  more  hearing  defects; 
the  percentages  for  the  two  groups  being  4  and  6.  The  retarded 
children  had  a  slightly  higher  percentage  of  vision  defects,  but  the 
difference  was  sHght,  27  and  29  per  cent.  The  difficulty  here  seems  to 
be  that  the  standard  for  defective  vision  was  set  too  low,  at  20/20 
probably,  instead  of  at  20/40.  According  to  the  writer's  studies  there 
were  probably  not  over  10  per  cent  of  the  children  who  were  actually 

'See  Parker's  "Methods  of  Teaching  in  High  Schools,"  chapter  on  Super- 
vised Study,  p.  396,  and  the  reference  at  the  end  of  this  section. 


APPENDIX   I  637 

defective  enough  to  require  glasses.  Had  this  seriously  defective  group 
been  picked  out,  the  differences  might  have  been  greater. 

In  this  study  the  number  of  children  of  normal  age  (1,279)  who  had 
failed  of  promotion  was  compared  with  another  group  (573)  who  had 
failed  and  were  retarded,  or  over  age,  for  their  grades.  The  two 
rroups  were  about  the  same  in  defectiveness  of  vision  and  hearing; 
ine  same  percentages  were  found  having  bad  health;  and  the  retarded 
children  were  worse  than  the  other  children  only  in  greater  irregularity 
of  attendance.  For  these  two  defects  and  general  health  at  the  time 
of  examination  there  seems  to  be  little  relation  to  school  progress. 
Irregular  attendance  was  positively  correlated,  and,  since  irregular 
attendance  is  closely  correlated  with  infectious  and  other  ailments 
which  keep  children  at  home,  these  two  defects  and  state  of  health 
at  the  time  of  examination  may  not  be  as  closely  correlated  with  school 
progress  as  are  the  illnesses  which  keep  children  at  home. 

GuUck  and  Ayres  also  report  Superintendent  Verplanck's  find- 
ings among  1,093  children  promoted  and  303  children  not  promoted. 
Seventy-seven  per  cent  of  those  not  promoted  were  defective,  while 
only  60  per  cent  of  those  promoted  were  defective.  The  figures  show 
that  for  adenoids  and  defective  teeth  the  percentages  were  consid- 
erably greater  among  the  not-promoted  group,  while  the  other  dif- 
ferences are  too  slight  to  be  significant. 

Superintendent  D.  C.  Bliss  also  made  similar  studies  in  1909-10 
while  he  was  at  Elmira,  New  York.  He  tabulated  the  physical  defects 
among  449  children,  of  whom  345  had  been  in  the  first  grade  two 
years,  86  three  years,  and  18  four  or  more  years.  The  cases  per  hun- 
dred children  having  six  separate  defects  for  these  three  groups  were 
respectively:  134,  139,  and  217.  The  correlation  between  retardation 
and  defectiveness  is  here  positive,  and  especially  so  for  those  chil- 
dren who  had  adenoids,  anemia,  and  rickets,  while  tonsils,  enlarged 
glands,  defective  vision,  and  defective  hearing  all  show  a  larger  num- 
ber of  cases  among  those  who  had  been  four  or  more  years  in  their 
grades  over  those  who  had  been  held  for  two  years  in  these  grades. 

Ayres's  own  findings  for  7,608  children  are  also  reported.  Only  75 
per  cent  of  the  retarded  children  were  defective  and  80  per  cent  of  the 
normal  children.  Analysis  of  these  unlooked-for  results  showed  that 
most  defects  and  ailments  fell  off  in  numbers  as  the  children  advanced 
in  age,  with  the  exception  of  defective  vision.  When  these  data  were 
studied  from  the  standpoint  of  each  age  group  for  six  defects,  namely, 
those  of  enlarged  glands,  defective  vision,  breathing,  teeth,  tonsils, 
and  adenoids,  and  from  the  standpoint  of  the  mentality  and  school 
progress  of  the  children,  the  bright  children  had  an  average  percent- 
age of  16  defects,  the  normal  19.6  defects,  and  the  dull  23.6  defects. 


638  APPENDIX    I 

The  average  loss  in  school  progress  of  children  with  defects  over  those 
without  defects  is  given  as  q  per  cent,  which  would  mean  a  loss  of  over 
a  year  in  passing  through  the  eight  grades  of  an  elementary  school. 
The  defects  are  also  given  in  the  order  of  their  retarding  effect,  enlarged 
glands  being  most  closely  correlated  with  school  failure:  enlarged  glands, 
adenoids,  enlarged  tonsils,  defective  breathing,  defective  teeth,  and 
defective  vision.  According  to  these  data  the  children  of  the  elemen- 
tary schools  who  have  defective  teeth  (at  least  half  of  them)  require 
about  a  half-year  more  in  completing  the  eight  grades  than  the  nor- 
mal child.  The  child  with  enlarged  glands  requires  one  and  two-tenths 
more  years  to  get  through  the  eight  grades. 

For  the  third  or  more  of  American  elementary-school  children  who 
have  two  or  more  defects  the  retarding  influences  have  not  been  de- 
termined. We  might  infer  that  they  would  be  much  greater.  However, 
it  has  been  found  that  in  perhaps  a  majority  of  cases  these  defects  are 
symptoms  of  bad  heredity  and  bad  home  conditions.  If  by  some 
means  we  could  get  all  these  defects  corrected,  we  might  find  with  no 
further  data  than  here  given  that  the  children  would  remain  just  as 
backward  after  correction.  We  must  have  the  results  of  correction 
followed  up  more  closely  in  order  to  eliminate  the  other  retarding 
forces  from  unduly  influencing  our  inductions.  If  we  find  in  general 
that  children  make  much  more  rapid  progress  after  the  correction  of 
defects  (and  the  elimination  of  absence  by  disease  prevention,  not  here 
included),  we  may  justly  infer  that  the  defects  and  diseases  were  prob- 
ably the  causes  of  school  backwardness  and  not  heredity  and  not  home 
and  other  environment.  Such  measures  of  school  progress  for  such 
purposes  should,  if  possible,  be  made  by  objective  scales  such  as  the 
Stone  and  Courtis  scales  for  arithmetic,  the  Ayres  and  Thorndike 
scales  for  handwriting,  the  Hillegass,  Ballou,  Courtis,  and  other  tests 
of  composition,  the  Thorndike  scales  for  reading  and  drawing,  the 
Buckingham  and  Ayres  tests  for  spelling,  and  others.  The  use  of 
the  objective  scale  eliminates  the  often  erroneous  and  non-comparable 
results  of  teacher's  examinations. 

The  general  result  of  the  investigations  summarized  by  Gulick  and 
Ayres  is  that  there  seems  to  be  a  definite  correlation  between  physical 
defects  and  retarded  school  progress. 

The  extensive  survey  of  data  along  this  line  given  in  the  writer's 
volume  on  "School  Health  Administration"  shows  the  same  correla- 
tion appearing  in  many  investigations. 

A  study  of  the  reports  of  the  visits  of  attendance  officers  to  the 
homes  of  absentees  from  school  shows  that  on  the  average  from  40 
to  70  per  cent  of  such  absences  are  caused  by  the  illness  of  a  pupil  him- 
self or  of  some  one  else  in  the  family.     This  is  especially  true  in  cities 


APPENDIX    I  639 

and  in  rural  regions  and  villages  where  school  attendance  has  become 
from  one  cause  or  other  an  established  habit.  Keyes  shows  in  his 
study  of  the  "Progress  through  the  Grades  of  City  Schools"  that  a 
close  correlation  exists  between  absence  and  non-promotion  and  that 
absences  under  a  month  retard  25  per  cent  of  the  pupils  sustaining 
such  loss;  that  absences  from  one  to  two  months,  as  in  the  case  of 
quarantine,  retard  50  per  cent  of  the  children;  and  that  absences 
exceeding  forty-nine  days  retard  about  75  per  cent  of  the  children 
absent. 

Doctor  Bachman  corroborates  these  results  in  his  investigation  of 
the  New  York  City  schools. 

In  this  volume  also  the  reports  of  many  city  superintendents  and 
health  officers  are  analyzed.  They  all  indicate  a  rather  close  connec- 
tion between  physical  defects,  illness,  and  minor  ailments  and  in- 
efficiency in  school  work.  The  final  rough  conclusion  is:  these  data 
seem  to  show  that  illness  and  physical  defects  in  school-children  are 
the  cause  of  almost  15  per  cent  of  elimination,  16  per  cent  of  non-pro- 
motion, and  17  per  cent  of  retardation  (p.  52). 

Doctor  Terman  furnishes  some  further  data  in  his  book  on  "The 
Hygiene  of  the  School  Child."  In  his  chapter  on  "The  Hygiene  of 
the  Nose  and  Throat"  he  summarizes  Bonassola's  findings  that  of 
141  out  of  400  school- children  who  displayed  symptoms  of  aprosexia, 
inability  to  give  attention,  117  had  adenoids  and  the  remaining  24 
all  had  some  kind  of  nasal  obstruction.  These,  of  course,  must  not 
have  all  been  cases  that  should  have  surgical  removal.  In  a  school 
of  375  boys  Wilbert  found  that  22  of  a  group  of  26  described  as  bad 
scholars  had  adenoids.  Terman  also  summarizes  Barr's  findings  in 
Glasgow,  Permewan's  studies  in  Liverpool,  Gelle's  study  in  Paris, 
Zhermunsky's  investigations  at  St.  Petersburg,  Kobrak's  study  at 
Breslau,  Wanner's  study  in  Munich,  and  others,  all  of  which  show  a 
fairly  close  correlation  between  school  progress  and  defective  hearing, 
from  only  slight  difficulty  of  hearing  in  one  ear  up  to  deafness  in  both. 
We  cannot  translate  their  results  into  a  general  standardized  state- 
ment of  the  percentage  effect  of  such  defects  upon  retardation,  but  it 
is  evident  that  it  is  one  of  the  serious  factors.  One  or  two  per  cent 
of  American  elementary-school  children  are  seriously  affected.  We 
shall  soon  be  able  to  say  what  percentage  of  this  group  is  retarded  by 
the  defect. 

Retardation  effects  of  malnutrition  are  also  given  by  Terman. 
Macmillan  and  Bodine  in  Chicago,  Harrington  in  Boston,  Doctor 
Warner  in  London,  Bean,  and  others  give  data  from  which  we  may 
estimate  that  from  20  to  over  50  per  cent  of  retarded  children 
suffer  from  malnutrition.    For  example,  Macmillan  and  Bodine  found 


640  APPENDIX    I 

thai  54.6  per  cent  of  2,100  retarded  children  suffered  from  malnu- 
trition. Doctor  Wallin's  study  of  the  relation  of  defective  mouth  con- 
ditions and  retardation  in  Cleveland  is  reported  by  both  Terman  and 
Rapeer.  It  seems  to  show  that  a  close  relationship  exists  between 
defective  teeth,  as  Ayres  found,  and  retardation.  Kohnky's  more 
recent  study,  using  a  control  class,  seems  to  verify  his  general  con- 
clusions without  such  a  check. 

In  The  Psychological  Clinic  for  January,  191 5,  Doctor  W.  L.  Foster 
gives  interesting  tables  and  graphic  representations  of  the  relation  of 
defective  teeth  to  scholarship.  Far  more  pupils  with  good  teeth 
passed  in  certain  schools  than  did  those  with  poor  teeth,  ranging  from 
50.6  per  cent  passing  in  all  subjects  who  had  but  one  decayed  tooth, 
down  to  3.2  per  cent  of  those  with  five  or  more  decayed  teeth.  He 
also  shows  incidentally  the  influence  of  giving  school  marks  for  con- 
dition of  the  teeth.  Based  on  the  number  of  decayed  teeth,  the  dental 
condition  of  the  pupils  given  this  incentive  improved  41  per  cent  in 
passing  through  the  grades. 

Doctor  Felix  Arnold,  in  the  same  number  of  the  magazine  men- 
tioned above,  shows  the  results  of  a  study  of  the  relation  of  obstructed 
breathing  (commonly  adenoids)  to  memory  work  in  school.  He  used 
cotton  and  paper  plugs  for  the  nostrils,  and  gave  memory  tests.  Pupils 
with  such  artificially  obstructed  breathing  did  poorer  work  than  the 
others.  He  concludes:  "In  terms  of  classroom  practise,  obstructed 
breathing  prevents  any  progress  through  drill,  and  hinders  assimila- 
tion of  new  matter  sufiiciently  to  cause  non-promotion  of  the  pupils 
concerned." 

Similar  critical  questions  will  arise  in  reviewing  these  investiga- 
tions as  with  others  mentioned,  for  example:  Was  it  the  condition  of 
the  teeth,  or  other  factors  associated  with  bad  teeth,  such  as  poor  home 
conditions,  and  possibly  heredity,  that  caused  the  lower  promotion 
rate?  How  much  more  did  these  pupils  give  attention  to  going  to 
the  dentist  under  this  incentive  as  they  grew  older  than  would  be 
found  in  other  schools  not  using  this  incentive?  Were  not  the  irri- 
tation of  the  plugs  used,  and  the  conditions  of  the  test,  for  the  second 
group  of  children,  suftlcicnt  to  account  for  their  poor  attention  or 
memory  work  ?  Did  such  plugs  function  at  all  as  do  ordinary  enlarged 
adenoids?  These  questions  are  not  answered  satisfactorily,  and  we 
can  only  conclude  that  these  experiments  seem  to  bear  out  the  general 
conclusion  that  there  is  a  positive  and  probably  close  correlation  be- 
tween physical  defects  and  ailments  on  the  one  hand  and  school 
progress  and  mental  (and  i)hyslcal)  efliciency  on  the  other. 

Terman  points  out  indirectly  that  school  progress  is  more  than 
mental  progress,  that  education  also  includes  physical  education  and 


APPENDIX    I  641 

development;  and  gives  the  results  of  many  studies,  showing  the 
evil  effects  of  physical  defects  and  illnesses  on  physical  development, 
growth,  and  health.  All  who  realize  that  the  schools  are  responsible 
for  an  all-round  education  of  the  nation's  future  citizens  must  appreci- 
ate the  fact  that  children  sometimes  pull  through  with  their  mental 
work  when  sufTering  from  defects  and  ailments,  and  that  thousands 
drop  by  the  wayside  in  early  life  from  many  diseases  which  are  very 
largely  preventable  through  a  socialized  education  and  which  have 
been  actually  encouraged  by  bad  school-life  conditions.  Malnutri- 
tion, adenoids,  enlarged  tonsils,  defective  teeth,  measles,  scarlet  fever, 
tuberculosis,  and  the  like  make  for  a  far  inferior  citizen  to  the  one 
which  the  school  is  responsible  for  developing.  National  degeneracy 
has  already  greatly  alarmed  some  of  the  older  nations,  and  its  spectre 
is  already  abroad  in  our  land,  as  many  valid  data,  such  as  mortality, 
insurance,  and  life-extension  statistics,  show. 

We  could  fill  a  volume  with  the  physical  evil  effects  of  ill  health 
and  physical  defects.  Rheumatism  usually  affects  the  heart;  scarlet 
fever,  measles,  and  such  diseases  quite  frequently  have  a  bad  effect 
on  the  eyes,  on  hearing,  and  on  the  general  constitution.  Medical 
books  and  papers  are  filled  with  data  along  this  line.  The  physical- 
educationist  can  find  plenty  of  data  to  prove  that  his  work  is  largely 
nullified  by  preventable  ailments  and  remediable  defects — that  a  nec- 
essary foundation  for  physical  education  must  be  the  prevention, 
treatment  and  correction  of  ailments  and  defects.  It  is  possible  to 
estimate  in  a  general  way  the  effect  of  illness  and  defects  on  retarda- 
tion and  to  estimate  the  cost  of  retardation  in  money  and  lost  edu- 
cation. Sordidly  and  financially  considered,  many  superintendents 
and  teachers  will  find  it  possible  to  show  that  the  general  saving  to 
the  parents  and  to  the  schools  in  money  each  year  will  far  more  than 
pay  for  elaborate  systems  of  educational  hygiene.  The  need  is  for 
more  careful  records  and  for  patient  study  of  such  data  in  the  way, 
for  example,  that  Mr.  Reavis  has  recently  investigated  "The  Relation 
between  the  Physical  and  Health  Conditions  of  Children  and  Their 
School  Progress"  {Elementary  School  Journal,  October,  1Q14)  and 
Professor  Baldwin  has  studied  "Physical  Growth  and  School  Prog- 
ress" (Bulletin  of  the  U.  S.  Bureau  of  Education). 


APPENDIX  III 

PHYSICAL-RECORD    CARD,    GIRLS'   HIGH   SCHOOL,  PRO- 
VIDING FOR  FOUR  ANNUAL  EXAMINATIONS 


WEST  PHILADELPHIA  HIGH  SCHOOL  FOR  GIRLS 
MEDICAL  INSPECTION  CARD 


me; 

(G 


Mua 


D„^ 

PudCTfAi  Signs  asd  Sntproiis 

".^^'.l' 

ExcLUsiOK  raoM  School                                                     DutAnox  oi  Exo-csioiii  raoti  Dire  or  Omsct 

K„„„ 

Ktient 

"".=0*;^' 

°^^'' 

PaUent 

—      "S^™T' 

^''"tr^hSr*^ 

.t= 

,;^= 

Jit. 

i„ 

Other  children  of 

-tsr  ^S'S" 

Sometime*  liegiiu  mth  reveriihncM  but  »  usually  very 
KCond  d»r  u  afoall  pimples,  which  in  about  a  day 

Oniet  iuidious,  may  be  rapid  or  ciadual.     Typicallv 
wie  throat,  great  weakncM,  andtwclling  of  lymph 
nodes  in  the  neck,  about  the  angle  of  the  jaw.     Tlie 
back  of  the  throat,  tomiU,  or  palate  may  ibow  patches 
likepicccsofgiayiih-whitckid.  The  moit  proooUDced 

in  i^ty''l4fyo«cal  diphtheria             P          «q         y 

Mouth     spray     and 
crmt  of  spots. 

-v^r 

^■^ 

-y^ 

"tar 

iithtnudday         returns-     A  mild  di^nM  and  seldom  any  after 

charges  from  nose. 

no     diphtheria 

ported   nega- 

showing  diph- 
theria bacilli 
*houU    be   tm- 

has  been  raised 
and  two  sucwv 

wltureflub^ 

?aj,y."'°'' 

from  no»e  and  throat  are  reported    [      after   cStcls      Whrn   diphtheria   ii^curv    m    i 
negative      .'^'ose    showing   dipb-    |      school,  all  children  luffcrinf  from  ^it  thrnai 

Begin*  like  cold  in  the  bead,  with  fcvenshneas,  runnins 
nooe.  inlUmed  and  watery  tya.  and  soeaing:  imoll 
creaccolk  croup*  ol  mulberry -tin  led  (pots  appear 
about  the  lliird  day;   nsh  fint  seen  on  forehead  and 
face      The  rsah  vans  with  heat;   may  almou  disap- 
pear i(  the  air  i»  cold,  and  come  out  again   with 

thing  bi"".                                                  ■i'"" 

llani^omriwliilrn  ,.nJ  l^ndrr  .Vn,^li"...'^.V^  uiff! 

yea. 

No.    '  Until  rtcovcry  and 

1     disinfection    ot 

pcnan:  at  least 

Eidude  untQ  isih  day  aftei  child  bat  nw  patient. 

school      during  1      risk  of  infection  first  three  or  four  diy*.  Uforc 
8th  to  i!th  day        the  rash  appeaii.    Great  variation  in  type  of 
after  child  lo^t        di»ase-    l!iaDgerou>  in  childien  under  >  years 

(German) 

""SS"'"^ 

No.      Until  recovesy  and 
S  days.' 

Exclude  unta  iid  day  after  chih]  laat  mw  p«lieai. 

school     during        frequently  confuted  with  scarfet  fever. 
iithtoijd^y 

.^ 

Ye*. 

~Ve^ 

^Hfvi-S- 

Exclude  ijtb  to  aid  day  after  child  lost  taw  patient. 

to  I  id  day  after 
chUd    last   saw 

'Stir;^'""'^^-  ^'"''""-^ 

FEVER 

fweruhDe«fc  mtc  thioat.  and  often  vomiting.     Vi^. 
ally  within  twenty-rour   houra  the  raah  appcan. 
fineljr  ipolted.  evenly  diffuied.  and  bright  red  ^e 

^  Wuthw  to^Wn  da^  when  il^Sy^d'tbe  sS'n 
P«*»  '1^^-  ^^:  "".  f*"™.  I*^  !"««■    ''T" 

ehantes  from  sup- 

•''airu?'^' 

Seven  days  from 
MwyiiUt. 

Until  Mven  dxy«  j  Seven  days  from  time  child  lost  saw 
afterquoranlmc,     patieltt. 

Dangerous  both  during   attack   and   from   after 

Many  mild  cases  not  diajcnosed  and  many  con- 
cealed.   The  peeling  may  bit  six  to  eiKbtwwks 
A  aecond  attack  is  rare.     When  scarlet  fever 

nas     About  third  day  a  ^  mih  nl  shotlik'e  pimS. 
fell  bdow  the  »kin,  and  seen  fir«it  about  tbe  lace  and 
wn*U:   spot!  develop  in  two  days,  then  form  little 
bliMen.  and  alter  two  daya  more  become  yellowish 

•cabs.           "    *" 

Recovei^  and  dis- 

Exclude  until  iid 
day  af^er  child 

infection  of  per- 

days  after  ouar-  \     day  after  child 

Exclude  iidoys  or 
7  days  after  iuc- 
c^ul  vaccina- 
tion, untewtb^^ 

ccMfuUy  vatti- 

year.  in  which 
case  they  may 

connection  with  s  vl...                                i   ■    ■ 
tohavealljKnons^.i"                                            i 

SEPTIC 

reddened  and  may  thow  patches  like  dtphlberio. 

Mouth  spny  and  dis- 
chMges  Horn  nme 

-v=r 

^ 

"IBr 

No.      Until  recovery. 

kidneys,  etc.     Very  apt  to  cause  epidemics  if 

*?Wh"^ 

lo™  "in"y  ' t^fiw  "h^'^'li*  ""i^d"'  'c^'i;ct^.^tJ^ 

■5Sr^ 

No.      EiKbi    weeks    or 

1      alter  lAt  char, 
.icteristit  couitb 

Fourteen  day».  provided  no  cough  develops  raeontune. 

After  cflecU  often  very  severe  and  di>ea*c  caus* 
great   drtiility.     ReUpies   arc   apt    to   occjir. 
Second   attai   rare.     SpecialK-   mfetUous  (or 

c 


.n..o,_,ora.ha..e.ond.„„_.r.a..nd._o,the.o,er^^ 


APPENDIX  IV 

THE    SCHOOL    COMMITTEE   OF   THE    CITY   OF   BOSTON. 
DEPARTMENT  OF  SCHOOL  HYGIENE 

To  Parents  and  Guardians: 

Diseases  of  the  teeth  have  been  named  "The  Disease  of  the  People." 
The  wide-spread  existence  of  this  disease  and  the  great  injury  it 

does  to  the  health  of  the  child  make  it  one  of  the  greatest  factors  in 

deciding  the  child's  future. 

The  cure  of  the  disease  calls  for  the  strong,  united  action  of  all 

persons  having  the  care  of  children. 

Good  Health  Depends  upon  Good  Teeth — Because 

1.  There  cannot  be  health  without  nourishment. 

2.  There  cannot  be  nourishment  unless  the  teeth  break  up  (chew) 
the  food  so  that  the  body  can  digest  the  food. 

3.  There  cannot  be  good  digestion  unless  the  teeth  are  able  to 
break  the  food,  and  bad  teeth  cannot  do  good  work. 

4.  If  there  is  not  good  digestion,  there  cannot  be  good  health. 
Medical  investigations  show  that  much  of  the  disease  of  the  teeth  can 
be  prevented  ;  also  that  the  younger  the  child  when  the  teeth  are 
cared  for,  the  greater  the  benefit. 

All  this  means  that  if  the  first,  or  temporary  set  of  teeth,  could  be 
kept  free  from  disease,  the  second  or  permanent  set  of  teeth  would  be 
practically  sound. 

Children  enter  school  life  just  before  or  during  the  most  impor- 
tant dental  period;  namely,  the  cutting  of  the  sixth- year  molar 
tooth.    This  is  the  first  permanent  tooth. 

This  first  tooth  of  the  second  set  will  not  be  healthy  and  sound  if 
the  first  set  of  teeth  is  decayed  or  neglected.  The  other  teeth  of  the 
SECOND  set  will  not  be  healthy  if  this  first  molar  is  decayed. 

The  one  great  cause  in  all  decay  of  teeth  is  the  failure  to  keep 
them  clean. 

There  was  a  time  when  the  wheat  used  for  flour  was  not  so  finely 

643 


044  APPENDIX    IV 

powdered  as  it  is  to-day,  and  when  modern  inventions  had  not  robbed 
l)rc'acl  of  a  coarseness  that  made  the  teeth  dean  and  strong  by  chewing. 
The  finely  powdered  wheat-flour  bread  clings  to  the  teeth  and  sets 
up  fermentation.  This  causes  decay  of  the  teeth.  This  decay  goes 
on  faster  during  the  night  than  during  the  day. 

Teeth  should  be  cleaned  after  each  meal  but  must  be  cleaned 
before  going  to  bed  each  night  if  decay  is  to  be  prevented. 

Teeth  can  be  cleaned  by  brushing  or  by  passing  silk  floss  between 
the  teeth. 

Many  children  neglect  to  do  this;  then  it  becomes  necessary  to 
have  the  teeth  cleaned  and  repaired  by  a  dentist. 

The  School  Committee  has  gone  over  the  whole  problem  of  the  care 
of  the  children's  teeth  and  has  prepared  a  plan  which,  it  believes,  will 
aid  the  children  greatly  in  promoting  good  health. 

The  task  is  a  big  one  and  requires  the  co-operation  of  parents  and 
teachers  if  the  best  results  are  to  be  gained. 

Each  parent  or  guardian  is  asked  to  assist  in  this  work  which 
means  so  much  for  the  future  of  the  children. 

1.  You  are  asked  to  buy  a  tooth-brush  for  each  child  in  the  family. 

2.  You  are  asked  to  see  that  the  child  uses  this  tooth-brush 
DAILY,  especially  before  going  to  bed  at  night. 

3.  You  are  asked  to  fill  out  and  sign  the  attached  form  so  that  the 
school  nurse  may  give  any  assistance  required  in  any  case.  This  will 
be  regarded  as  confidential. 

4.  You  are  asked  to  attend  the  Free  Lecture  and  Demonstration  to 
be  given  by  dentists  at  the  school  your  children  attend. 

5.  You  are  requested  to  take  your  child  to  your  family  dentist 
for  examination  and  for  treatment.  If  circumstances  do  not  permit 
consulting  a  dentist  at  his  office,  the  child  may  be  treated,  at  a  small 
cost,  or  free,  at  one  of  the  following  dental  clinics.  You  are  asked  to 
do  this  NOW. 

Boston  Dispensary,  Bennett  Street,  5  dentists,  9  a.m.,  daily. 
Harvard  Dental  School,  Longwood  Avenue,  55  dentists,  9  a.m.  to 

2  p.m.,  daily. 
Tufts  Dental  School,  Huntington  Avenue,  80  dentists,  9  a.m.,  daily. 
Massachusetts   General   Hospital,   Blossom   Street,   4  dentists,   8.30 

a.m.,  daily. 
Mt.  Sinai  Hospital,  Staniford  Street,  i  dentist,  9  a.m.,  daily. 
Hull  House  Dispensary,  Hull  Street,  i  dentist,  9  a.m.,  daily. 


APPENDIX   IV  645 

Grace  Hospital,  Kingston  Street,  4  dentists,  9  a.m.,  daily. 
Maverick  Dispensary,  Maverick  Square,  i  dentist,  10  a.m.,  Tuesday 
and  Thursday. 

Respectfully, 

Thomas  F.  Harrington,  M.D., 

Director  of  School  Hygiene. 


Fill  out  and  tear  off  this  slip  and  return  it  immediately. 

191     • 

To  the  Principal  of School. 

A a  pupil  in  Grade is  receiving  treatment  at 

Dr or  at 

Hospital,  or 

B.     I  desire a  pupil  in   Grade to  receive  dental 

treatment  at Hospital. 

I  assume  the  responsibility  of  such  visits.    I  ^  pay  minimum 

^  ^  cannot  ^  •' 

cost  of  treatment 


Parent  or  Guardian. 


INDEX 


Abt,  Doctor  I.  A.,  62 
Administration  of  educational  hygiene, 

134 
Ailments  in  order  of  frequency,  228 
Ailments  of  pupils,  223 
Aims  of  physical  education,  620 
Alderman,  E.  L.,  181 
Allen,  VV.  H.,  loi 

American  Medical  Association,  4,  5 
Andrews,  J.  B.,  28 
Apparatus,  play,  405 
Arithmetic,  hygiene  of,  591 
Association,  581 
Athletic  games,  401 
Athletic  test,  464 
Athletics  in  high  school,  439,  453 
Attention,  580 
AjTes,  L.  P.,  17,  120,  296 

Babbitt,  Ellen  C,  36 

Badge  for  athletics,  418 

Biotype,  47 

Blackboards,  350 

Bliss.  D.  C,  173 

Blind  children,  436 

Boy  Scouts,  468 

Brown,  E.  F.,  283 

Building  rules,  :i^^ 

Bureau  of  Municipal  Research,  92 

Cabot,  Ella  L.,  84 

Camp-Fire  Girls,  469 

Cancer,  26 

Carnegie  Foundation,  85 

Carney,  Mabel,  112 

Charitable  societies,  96 

Child  development,  stages  of,  551,  570 

Child-welfare  exhibits,  91 

Children's  Aid  Society,  244 

Chorea,  64 


ChurchiU,  J.  A.,  184 

Classification    of    mental    defectives, 

296 
Classroom,  standard,  338 
Cleanhness  and  cleaning,  89,  185,  351, 

364 
Chnics,  school,  137,  253 
Codes,  223,  234 
College   credit,    lack    of,    for   health 

teaching,  504 
College  hygiene,  602,  617 
CoUi^r,  Price,  i 

Communicable  ailments,  41,  224 
Consolidated  rural  school,  323,  459 
Contagious  diseases,  41,  224 
Co-operation,  public,  82,  245 
Cornell,  17 

Country  school  farm,  323 
County  superintendents,  194 
Crippled  children,  436 
Criticism,  service  of,  83 
Crowley,  Doctor  Ralph,  311 
Cruickshank,  L.  D.,  225 
Curtis,  S.  H.,  123 

Dancing,  447 

Deaf  children,  436 

Death  losses,  i,  7,  8,  10,  11,  14, 15,  16, 

25,  26,  27,  28 
Death-rates  at  various  ages,  14,  15 
Defects  of  pupils,  223 
Degenerative  diseases,  death-rates  of, 

26 
Denison,  Elsa,  88 
Dental  chairs,  237 
Dentists'  organizations,  95 
Desks,  351 
Determiners,  50 
Devine,  13 
Dewey,  John,  381 


647 


648 


INDEX 


Diagnosis  of  mental  defects,  304 

Diagnostic  chart,  113 

Diet,  68  — .--'^' 

Dietaries,  290 

Diphtheria,  39 

Diseases  of  pupils,  223 

Disinfection,  40 

Ditman,  59 

Divisions  of  educational  hygiene,  130, 

Drawing,  hygiene  of,  598 
Dresslar,  F.  B.,  5,  86,  121,  124 
Drills,  physical,  429 
Dunn,  31 

Educating  the  public,  100 
Educational  hygiene,  meaning,  4 
Educational  psychology,  5 
Ellis,  Professor  Caswell,  348 
Emergency  outfit,  486 
Employers  and  health,  543 
Equipment,  play,  405,  462;    dental, 

254 
Eugenics,  3,  48,  55 
Eugenics  Record  Office,  56 
Examinations,  156,  216 
Exceptional  children,  204 
Exclusion  form,  208 
Excursions,  467 
Exhibits,  90 

Expenditures  for  health  work,  43 
Eyes,  ears,  nose,  and  throat,  disorders 

of,  79,  80 

Fatigue,  67 

Fears  of  children,  66 

Feeble-minded  children,  302 

Feeding  of  school-children,  76,  273 

Festivals,  play,  466 

Fire-proofing  and  fire  laws,  335-7 

First-aid  supplies,  486 

Fisher,  Irving,  7 

Fisk,  E.  L.,  27 

Folk  dances,  416 

Foods  for  school-children,  70-77 

Forms  for  medical  supervision,  205-8 

Forsyth  Dental  Infirmary,  252 

Freeman,  R.  G.,  34 


Games,  447,  460 
Gamete,  48 

Geography,  hygiene  of,  593 
Girl  problem,  396 
Girl,  the  working,  541 
Girls'  athletics,  422 
Goldwater,  S.  S.,  199 
Green,  F.  R.,  22 
Grounds,  359 
Gulick,  L.  H.,  88 
Guthrie,  L.  G.,  60 
Gymnastics,  444 

Habit  spasms,  64 

Habits,  health,  482 

Harriman,  Mrs.  E.  H.,  56 

Headache,  78 

Health  agencies,  150 

Health  almanacs,  182 

Health  census  of  school-children,  197 

Health  grading  of  the  school-child,  114 

Health  and  heredity,  51,  52,  53,  60 

Health  programme,  491 

Health  surveys,  112 

Heating  and  ventilation,  343,  360 

Heredity  and  environment,  3,  45,  46, 

47,  60 
Hill,  L.  P.,  345 
Hoag's  diagnostic  chart,  113 
Home  hygiene,  531 
Hospitals,  96 
How  to  start  open-air  schools,   271; 

clinics,    253;    medical   supervision, 

etc.,  no 
Hutchinson,  Woods,  67 
Hygeia,  499 

Hygiene  of  instruction,  567 
Hygiene  of  methods,  124 
Hygiene,  teaching,  472 
Hygrometers,  349 

Ideals  of  health,  489 

Illness  and  physical  defects,  losses,  9, 

17,  18,  19,  20 
Individual  differences,  46-53 
Industrial  hygiene,  538 
Infant  mortality,  8,  14,  15,  18,  19,  32, 

33,  34,  35,  36 


INDEX 


649 


Infant  welfare  organizations,  259 
Inspection  of  pupils,  204 

Jaffa,  Doctor  Adele,  68 
Janitors,  326 
Johnston,  Charles  H.,  56 
Jordan,  D.  S.,  in 

Kennard,  Beulah,  381 
Kentucky  sanitary  privy,  369 
Kerschensteiner,  Doctor,  542 
Kirk,  John  R.,  356 
Kohnky,  Emma,  19,  249 

Life  Extension  Institute,  132,  543 
Life-insurance  agencies,  health  work 

of,  2 
Lighting,  339,  359 
Little  mothers'  classes,  236 
Longevity  and  heredity,  55 
Lunches  and  food  values,  75,  275,  277 

McMurry,  Professor  Frank,  473 

Malnutrition,  286 

Manhattan  Trade  School,  542 

Manual  training,  159 

Measles,  38 

Measuring  the  efficiency  of  medical 

supervision,  226 
Medical  inspection  laws,  187 
Medical  supervision  forms,  205-8 
Medical  supervision,  phases  of,  202 
Men's  colleges,  61 7 
Mental  development  and  heredity,  53 
Mental  hygiene,  579 
Mentally  defective  children,  204 
Methods  of  teaching  hygiene,  481 
Milk  stations,  33 
Mimetic  exercises,  416 
Moral  development  and  heredity,  55 
Morse,  Doctor  J.  L.,  40 
Mortality  statistics,  9,  10,  11,  25 
Moving-picture  show,  402 

National  vitality,  7 
Nervous  disorders,  61,  63 
NewTnayer,  S.  W.,  36,  88 
Newspapers,  91,  112 


Nose-blowing  drills,  235 

Notices  to  parents,  220,  222 

Nurse  as  attendance  officer,  215 

Nurses,  school,  145,  161;  qualifica- 
tions, 237 

Nurses  settlements  and  societies,  93, 
97 

Nurses,  training  of,  527 

Nuttall,  G.  N.  F.,  24 

Open-air  school  children,  feeding  of, 

284 
Open-air  schools,  256 

Parents'  health  responsibilities,  59 

Parent-teacher  associations,  98 

Pasteur,  Louis,  16 

Pearson,  Karl,  42 

Pennsylvania  Rural  School  Survey,  20, 
121 

Philanthropists,  99 

Physical  defects,  17,  18,  19,  20;  and 
heredity,  51 

Physical  defects  of  college  students, 
624 

Physical  education,  123,  410 

Physical  education,  aims  of,  441 

Physical  status  of  high-school  pupils, 
500 

Physical  training,  410 

Play  and  playgrounds  in  cities,  380 

Play  equipment,  462 

Play  instincts,  392 

Playground  Magazine,  123 

Polyclinic,  244 

Prenatal  health  work,  34 

Preventability  of  deaths  of  school- 
children, 16,  17 

Preventive  medicine  vs.  curative  medi- 
cine, 2,  23,  24,  510 

Prolongation  of  life,  24 

Psychological  examinations,  307 

Public-health  services,  4 

Public  opinion  and  sentiment,  87,  88, 
no,  124,  518 

Publicity,  89 

Pupil's  Health  Record,  206 

Pure  food,  30,  31,  32 


050 


INDEX 


1 


Reading,  hygiene  of,  586 

Record  cards,  health,  205-9 

Records,  physical  training,  432 

Recreative  exercises,  415 

Reesor,  Mary,  124 

Registration  of  deaths,  1 2 

Relief  organizations,  236 

Reports  of  medical  supervision,  2  lo-ii 

Research  in  educational  hygiene,  172, 

247 
Resistance  to  disease,  54 
Retardation  and  health,  17, 18, 19,  20, 

165;  Appendix  I. 
Rittenhouse,  26 
Rockefeller  Institute,  85 
Roller  towels,  22 
Rosenau,  51 
Rucker,  Doctor,  40 
Rules  and  regulations,  239 
Rural  hygiene  working  forces,  193 
Rural  play,  456 
Rural  school  sanitation,  355 

Sage  Foundation,  83 

Saint  Vitus's  Dance.     See  Chorea 

Salaried  medical  profession,  need  of,  2 

Sanitary  commandments,  379 

Sanitary  survey  forms,  216 

Sanitation  forms,  121,  122,  123 

Sanitation  of  schools,  312 

Saturday  half-holiday,  470 

Scarlet  fever,  39 

Schaeffer,  N.  C,  20 

School  examinations  and  adult  exam- 
inations, 199 

School  health  problem,  13 

School  medical  supervision,  37 

Seating,  187 

Sewage  disposal,  371 

Sex  education,  547 

Sex  instruction  in  the  high  schools, 
555;   in  elementary  schools,  557 

Sites  for  schools,  333 

Social  centre  as  a  health  agency,  103, 
108,  471 

Spelling,  hygiene  of,  599 

Stammering  and  stuttering,  67 


Standardization  clinic,  203 

Standards :  of  sanitation,  330 ;  for 
classroom,  338;  for  rural  schools, 
372;  for  playgrounds,  404;  for  ath- 
letics, 464;  for  teaching  hygiene, 
475;  for  professional  training  of 
nurses,  533 

State  co-operation  for  school  health 
progress,  147-8 

State  health  examinations,  2cxj 

Supplies,  233 

Survey,  health,  112,  317 

Symptom  chart,  113,  214 

Teachers'  meetings,  180 

Teaching  health,  status  of,  503,  522 

Teaching  hygiene,  123,  472 

Teeth  and  mouth  conditions,  80,  245 

Terman,  L.  M.,  66 

Texts  in  hygiene,  477-8,  488,  544 

Thorndike,  46 

Toilets,  353,  368 

Training  school-health  workers,  135 

Treatment  of  pupils,  225,  232,  251 

Tuberculosis,  38,  257 

Typhoid  fever,  28,  29 

Vaccination,  41 
Van  Sickle,  J.  H.,  296 
Ventilation,  79,  325,  331,  343 
Voluntary  assistance,  100 

Wald,  LilUan  D.,  231 

Wallin,  19,  20 

Warner,  Doctor  Francis,  61 

Water  supply  for  schools,  350,  365 

Whooping-cough,  37 

Wider  use  of  the  school  plant,  91 

Winslow,  C.  E.  A.,  2,  3,  14,  30 

Witmer,  Professor  L.,  296 

Women's  clubs,  88,  98 

Women's  colleges,  602 

Wood,  T.  D.,  113 

Work,  optimum  conditions  of,  576 

Workers  and  health,  539 

Writing,  hygiene  of,  596 


This  book  is  DUE  on  the  last  date  stamped  below 


OCT  1  7  1932 

APH  121931 
APR  141937 

MAY  I  0  M» 

vm 

, 

1 

EB  161938 

f-!- 

[JUL   2  3    1941 

^  121936 

'—  <i3l93f 

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MAY   i  0  .^ 
JCT  1719®! 

Ar'K  ZUi^/JO 

^^NIAR  2  2  RECO 

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